[Acute abdominal surgical pathology complicated with haemorrhagic shock in elderly patients treated in intensive care...

Elderly patients suffering from acute surgical pathology and severe medical comorbidities present serious "mix-cases" and their multiple organ detorioration requires perioperative intensive care.

analysis of outcome of elderly patients, aged 65 years and over, suffering from acute abdominal surgical pathology associated with haemorrhagic shock.

17,573 patients were treated in the 2nd Chair and Department of Surgery in Jagiellonian University Hospital within 01.07.1997 and 30.06.2003. 365 patients, aged >65 yrs underwent surgery because of acute abdominal pathology; 86 cases out of this group presented haemorrhagic shock, 69 of them had bleeding into the gastrointestinal tract, and in 17 there was diagnosed ruptured abdominal aortic aneurysm. The principles of the diagnosis and the therapy were common for both groups. The analysis included: mortality rate, duration of hospital and intensive care unit (ICU) stay, continuous assessment based on APACHE II (Acute Physiology And Chronic Health Evaluation) and TISS-28 (Therapeutic Intervention Scoring System).

Mortality rate was 71.01% in the group of 69 patients with gastrointestinal bleeding (there is no comparative data based on relevant cases in the literature), and 58.8% in the group with ruptured abdominal aneurysm. The difference in those values was caused by prolonged time (i.e. days), which elapsed from the onset of symptoms of pathology and commencing surgery and intensive therapy. In the group with ruptured aneurysm, the dramatic onset of symptoms reduced the time between commencing of pathology and the intensive treatment and procedure.