Emergency Abdominal Surgery in the Elderly: Can We Predict Mortality?

Area of Science:

• Geriatric Surgery
• Surgical Outcomes Research
• Health Services Research

Background:

• The UK population is aging, with over 70s comprising half of emergency laparotomy patients.
• These patients have high 30-day mortality (20%) and suboptimal care rates.
• Frailty and delayed management are linked to poor surgical outcomes.

Purpose of the Study:

• To evaluate the P-POSSUM risk score's accuracy in predicting inpatient mortality for patients over 70 undergoing emergency laparotomy.
• To determine if delayed care correlates with 30-day mortality in this demographic.

Main Methods:

• An observational study included 193 consecutive patients aged 70+ undergoing emergency laparotomy.
• Pre-operative P-POSSUM, ASA grade, and lactate levels were assessed for predictive value.
• Key management timings were analyzed against 30-day survival.

Main Results:

• P-POSSUM, ASA grade, and lactate showed moderate predictive ability for mortality (AUCs 0.784, 0.771, 0.705).
• No significant correlation was found between P-POSSUM scores and time to death.
• No delays in critical management steps were observed in patients who died within 30 days.

Conclusions:

• P-POSSUM offers moderate discrimination for inpatient mortality in this high-risk group.
• Incorporating frailty scoring could enhance risk stratification for emergency laparotomy patients over 70.
• Further research into frailty assessment is recommended for improved outcomes.