TY - JOUR
T1 - Never giving up
T2 - outcomes and presentation of emergency general surgery in geriatric octogenarian and nonagenarian patients
AU - Shah, Adil A.
AU - Zafar, Syed Nabeel
AU - Kodadek, Lisa M.
AU - Zogg, Cheryl K.
AU - Chapital, Alyssa B.
AU - Iqbal, Aftab
AU - Greene, Wendy R.
AU - Cornwell, Edward E.
AU - Havens, Joaquim
AU - Nitzschke, Stephanie
AU - Cooper, Zara
AU - Salim, Ali
AU - Haider, Adil H.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults. Methods Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared. Results Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to.88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500). Conclusions Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a “survivorship tendency” to never give up, despite collectively higher mortality risk.
AB - Background Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults. Methods Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared. Results Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to.88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500). Conclusions Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a “survivorship tendency” to never give up, despite collectively higher mortality risk.
KW - Emergency general surgery
KW - Geriatric
KW - Nonagenarian
KW - Octogenarian
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=84964324593&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2016.01.021
DO - 10.1016/j.amjsurg.2016.01.021
M3 - Article
C2 - 27086200
AN - SCOPUS:84964324593
SN - 0002-9610
VL - 212
SP - 211-220.e3
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 2
ER -