A. A. Shah1,2, H. Zafar2, R. Riviello1, C. K. Zogg1, S. Zafar4, A. Latif5, Z. Rehman2, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 2Aga Khan University Medical College,Department Of Surgery,Karachi, Sindh, Pakistan 3Harvard School Of Medicine,Center For Surgery And Public Health, Brigham And Women’s Hospital,Brookline, MA, USA 4Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 5Johns Hopkins University School Of Medicine,Department Of Anesthesia,Baltimore, MD, USA
Introduction: Geriatric surgical outcomes remain grossly understudied in low-middle income healthcare settings. The purpose of this study was to compare epidemiology and outcomes between old and young adults presenting to a tertiary care facility in South Asia for emergency general surgical (EGS) conditions.
Methods: Discharge data from a university hospital were obtained for all adult patients (≥16 years) presenting between March 2009 and April 2014 with ICD-9-CM diagnosis codes consistent with an EGS condition, as described by the American Association for the Surgery of Trauma (AAST). The patient population was dichotomized into old (>65 years) and young (≤65 years) adults. Multivariate analyses, accounting for age, gender, year of admission, type of admission, admitting specialty, length of stay (LOS), major complications and Charlson Comorbidity Index, were used to compare the two populations. Outcomes of interest included all-cause mortality, major complications and LOS.
Results: A total of 13,893 patients were included. Patients >65 years constituted 15.3% (n=2,123) of the patient population. Old adults were more likely to be male (OR[95%CI]:1.14 [1.02-1.27]) and present through the ED (OR[95%CI]: 1.22[1.09-1.38]). They more commonly presented with gastrointestinal bleeding (OR[95%CI]: 2.63[1.99-3.46]) and for resuscitation (OR[95%CI]: 2.17 [1.67-2.80]). After multivariate adjustment, age >65 years independently accounted for a 60% increase in mortality (OR[95%CI]: 1.60[1.18-2.16]). Elderly patients also had a higher likelihood of developing major complications (OR[95%CI]: 2.09[1.67-2.61]). There were no significant differences in lengths of hospital stay between elderly and young-adult patients (4.3 vs. 4.5 days, respectively).
Conclusion: Older adults seem to suffer from a different set of EGS conditions compared to their younger counterparts. The results of this study will assist in formulating specialized management guidelines and help prioritize care for geriatric patients with EGS conditions in low-middle income healthcare settings.
