No News is Good News? Three-year Post-Discharge Mortality of Octogenarian and Nonagenarian Patients Following Emergency General Surgery.

BACKGROUND: Outcome data on the very elderly patients undergoing emergency general surgery (EGS) are sparse. We sought to examine short and long-term mortality in the 80+ population following EGS. METHODS: Using our institutional 2008-2018 EGS Database, all the 80+ patients undergoing EGS were identified. The data were linked to the Social Security Death Index to determine cumulative mortality rates up to 3 years after discharge. Univariate and multivariable logistic regression analyses were used to determine predictors of in-hospital and 1-year cumulative mortality. RESULTS: A total of 385 patients were included with a mean age of 84; 54% were female. The 2 most common comorbidities were hypertension (76.1%), and cardiovascular disease (40.5%). The most common procedures performed were colectomy (20.0%), small bowel resection (18.2%), and exploratory laparotomy for other procedures (15.3%; e.g. internal hernia, perforated peptic ulcer). The overall in-hospital mortality was 18.7%. Cumulative mortality rates at 1, 2, and 3 years after discharge were 34.3%, 40.5%, & 43.4%, respectively. The EGS procedure associated with the highest 1-year mortality was colectomy (49.4%). Although hypertension, renal failure, hypoalbuminemia, hyperbilirubinemia, and elevated liver enzymes predicted in-hospital mortality, the only independent predictors of cumulative 1-year mortality were hypoalbuminemia (OR 2.17, 95%CI 1.10-4.27; p= 0.025), and elevated serum SGOT level (OR 2.56, 95%CI 1.09-4.70; p=0.029) at initial presentation. Patients with both factors had a cumulative 1-year mortality rate of 75.0%. CONCLUSION: More than half of the very elderly patients undergoing major EGS were still alive at 3 years post-discharge. The combination of hypoalbuminemia and elevated liver enzymes predicted the highest 1-year mortality. Such information can prove useful for patient and family counseling preoperatively. LEVEL OF EVIDENCE: Prognostic, level III.