Abdominal emergency surgery in patients over 90 years old: is it worthwhile? An Italian multicenter retrospective study

Unlike other surgical fields, such as cardiac surgery, where many trials have been made about safety, feasibility and outcome of surgical procedures in the elderly, there is lack of literature about emergency abdominal surgery in very old patients, especially in people over 90 years of age. The available data reported survival of about 50% one year after the operation. The aim of the study is to determine the survival rate two years after emergency abdominal surgery in a nonagenarian population and to identify any demographic and surgical parameters that could predict a poor outcome in this type of patient. The study was a retrospective multicenter trial. Patient inclusion criteria were: age 90 years old or older, urgent abdominal surgery. The medical charts reviewed and data collected were: gender, age, the American Society of Anesthesiologists (ASA) score and comorbidities, diagnosis, time elapsed between arrival to the Emergency Room and admission to the Operatory Room, surgical procedures, open versus laparoscopic procedure, type of anesthesia and outcomes with hospital length of stay. Phone call follow-up was performed for patient discharged alive and Kaplan-Meier analysis was used to evaluate survival. We identified 72 (20 males and 52 females) nonagenarian patients who underwent abdominal emergency surgery at 6 Italian hospitals (Parma, Bergamo, Bologna, Brescia, Chiari, Adria). Mean age was 92.5 years [range 90-100, standard deviation (SD) 2.6], median ASA score was 3 (range 2-5, mean 3.32) and only 7 patients were without comorbidities. Mean hospital length of stay was 13 days (range 1-60, SD 11.52); 56 patients (77.7%) were discharged alive; 2 years survival rate was 23% [mean follow-up=10 months (range 1-27)]. Among all the parameters analyzed, only ASA score was significantly correlated with survival. Neither the presence of malignancy nor the absence of comorbidities seems to correlate with survival. Nonagenarian patients undergoing emergent abdominal surgical procedures have a high overall in-hospital mortality rate (23%) and a low 2 years survival rate (51.4%). Except for ASA score, there are no other factors predicting poor outcome. Based on the present study emergency abdominal surgery in frail patients over 90 years of age has to be carefully evaluated: only 1 out 5 patients will be alive after 2 years.