The acute surgical admission: is mortality predictable in the elderly?

Area of Science:

• Geriatric Surgery
• Surgical Outcomes Research
• Predictive Analytics in Medicine

Background:

• Complex scoring systems often used to predict mortality can be challenging in clinical practice.
• There is a need for simple, effective preoperative assessments for elderly patients undergoing emergency surgery.

Purpose of the Study:

• To evaluate the Sickness Assessment (SA) as a predictor of mortality in elderly patients admitted for surgical emergencies.
• To compare the predictive performance of SA with the APACHE II score.

Main Methods:

• A prospective study of 487 consecutive patients aged over 65 admitted as surgical emergencies.
• The Sickness Assessment (SA) and APACHE II score were calculated upon admission.
• Hospital mortality was the primary endpoint, analyzed in relation to SA scores.

Main Results:

• Patients with a positive SA score had a significantly higher mortality rate (36%) compared to those with a zero SA score (7%) (P < 0.001).
• Mortality after laparotomy was substantially higher in patients with a positive SA (57%) versus a zero SA (15%) (P < 0.001).
• Hypotension on admission was a critical factor, associated with 77% mortality.
• The SA demonstrated comparable predictive ability to the APACHE II score.

Conclusions:

• The Sickness Assessment (SA) is a simple, effective preoperative tool for identifying high-risk elderly patients in surgical emergencies.
• Implementing SA in emergency surgical practice can potentially improve patient outcomes and guide decisions regarding surgery.
• SA offers a valuable alternative to more complex scoring systems for mortality prediction.