- Email: [email protected]
Outcomes for Emergent Surgical Procedures in Octogenarians: A 7-year experience from the American College of Surgeons National Surgical Quality Improvement Data
Vol. 221, No. 4S1, October 2015
Scientific Forum Abstracts
S83
intracranial hemorrhage (ICH) are lacking. In most institutions, these patients are routinely admitted to ICUs; we observe the majority in progressive care units (PCU). The goal of this study was to investigate the rates of ICU upgrade, intervention, and mortality of this group.
underwent emergent appendectomy (n ¼ 1,440: 34.2% open and 65.8% laparoscopic), cholecystectomy (n ¼ 1,252: 33.9% open and 66.1% laparoscopic), inguinal/umbilical hernia (n ¼ 1197: 95.5% open and 4.5% laparoscopic), and Hartmann’s procedure (n ¼ 1,127).
METHODS: A 12-year retrospective review was performed on elderly patients admitted to a level I trauma center after isolated mild traumatic brain injury (mTBI) (GCS 13) with ICH. Demographic information, arrival Glasgow Coma Scale, head AIS (HAIS), and CT head (CTH) findings and location of admission were collected. Outcomes measures included neurosurgical intervention (NSI) and mortality. Risk factors for NSI were examined using Pearson chi-square test.
RESULTS: The mortality for all emergent surgical procedures decreased from 8.8% to 7.3% (p ¼ 0.63): appendectomy 4.3% (p ¼ 0.28), hernia 7.3% (p ¼ 0.30), cholecystectomy 1.8% (p ¼0. 37) (Fig). The mortality increased for Hartmann’s by 7.4% (p ¼ 0.40). Mortality was lower for laparoscopic procedures than open procedures: appendectomy (2.2% vs 4.4 %, p ¼0.024), hernia (1.9% vs 6.1 %, p ¼ 0.22), and cholecystectomy (3.24% vs 13.1 %, p <0.0001). Mortality for hernia and appendectomy was lower in women than men (1.8 vs 4% and 4 vs 7.2% , p <0.05).
RESULTS: There were 245 elderly patients with mTBI identified (Table); 64% of patients were admitted to the PCU, with 10 requiring upgrade (6.4%). Those upgraded had higher rates of NSI and mortality (Table). The rate of NSI was significantly higher in patients with GCS¼13, HAIS¼5, or presence of mass effect (33%, 64%, 45%, respectively p0.05 for all). Table 1. Outcomes of Elderly Patients with Mild Traumatic Brain Injury n/group Disposition Overall PCU PCU/ICU upgrade ICU
NSI
Mortality
n
%
Head AIS, mean (SD)
n
%
n
%
245 146
100 59
3.7 (0.75) 3.5 (0.67)
34 1
14 0.7
20 1
8 0.7
10 89
4 36
4.3 (0.67) 4.1 (0.75)
5 28
50.0 31.5
3 16
30.0 18.0
NSI, neurosurgical intervention, PCU, progressive care unit.
CONCLUSIONS: The majority of elderly patients with mTBI and ICH can be safely observed outside ICUs. However, patients requiring escalation (6.4%) in care have a worse outcome. Patients with GCS¼13, HAIS¼5, or presence of mass effect have higher rates of NSI and should be observed in ICUs. New guidelines are needed to optimize outcomes and resource use in this growing population. Outcomes for Emergent Surgical Procedures in Octogenarians: A 7-year experience from the American College of Surgeons National Surgical Quality Improvement Data Busayo B Irojah, MD York Hospital, York, PA INTRODUCTION: Octogenarians represent a small but growing portion of the population. By 2050, it is projected that individuals over the age of 80 will constitute 7.4% of the US population. The purpose of this study was to assess the mortality of select general surgical procedures in octogenarians to guide surgeons in counseling patients. METHODS: Using the ACS NSQIP database (2005-2012), a retrospective analysis was done of 5,016 octogenarians who
CONCLUSIONS: Between 2005 and 2012, the mortality for select general surgical procedures decreased; however, the decrease was not statistically significant. Octogenarians still have a high mortality of about 7%. The mortality for laparoscopic procedures was lower than for open procedures. Mortality in colorectal operations remains significantly higher and needs further investigation. Redefining the Association Between Old Age and Poor Outcomes after Trauma: The Impact of the Frailty Syndrome Tahereh O Jokar, MD, Peter M Rhee, MD, FACS, Bardiya Zangbar, MD, Narong Kulvatunyou, MD, FACS, Mazhar Khalil, MD, Terence O’Keeffe, MB, ChB, FACS, Andrew L Tang, MD, FACS, Randall S Friese, MD, FACS, Lynn M Gries, MD, Bellal Joseph, MD, FACS University of Arizona, Tucson, AZ INTRODUCTION: Frailty syndrome (FS) is a well-established measure of poor outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and determine its association with post-trauma morbidity, trauma readmissions, and 6-month mortality. METHODS: We performed a 2-year prospective cohort analysis of all geriatric (age 65 y) trauma patients. Frailty syndrome was
Scientific Forum Abstracts
S83
intracranial hemorrhage (ICH) are lacking. In most institutions, these patients are routinely admitted to ICUs; we observe the majority in progressive care units (PCU). The goal of this study was to investigate the rates of ICU upgrade, intervention, and mortality of this group.
underwent emergent appendectomy (n ¼ 1,440: 34.2% open and 65.8% laparoscopic), cholecystectomy (n ¼ 1,252: 33.9% open and 66.1% laparoscopic), inguinal/umbilical hernia (n ¼ 1197: 95.5% open and 4.5% laparoscopic), and Hartmann’s procedure (n ¼ 1,127).
METHODS: A 12-year retrospective review was performed on elderly patients admitted to a level I trauma center after isolated mild traumatic brain injury (mTBI) (GCS 13) with ICH. Demographic information, arrival Glasgow Coma Scale, head AIS (HAIS), and CT head (CTH) findings and location of admission were collected. Outcomes measures included neurosurgical intervention (NSI) and mortality. Risk factors for NSI were examined using Pearson chi-square test.
RESULTS: The mortality for all emergent surgical procedures decreased from 8.8% to 7.3% (p ¼ 0.63): appendectomy 4.3% (p ¼ 0.28), hernia 7.3% (p ¼ 0.30), cholecystectomy 1.8% (p ¼0. 37) (Fig). The mortality increased for Hartmann’s by 7.4% (p ¼ 0.40). Mortality was lower for laparoscopic procedures than open procedures: appendectomy (2.2% vs 4.4 %, p ¼0.024), hernia (1.9% vs 6.1 %, p ¼ 0.22), and cholecystectomy (3.24% vs 13.1 %, p <0.0001). Mortality for hernia and appendectomy was lower in women than men (1.8 vs 4% and 4 vs 7.2% , p <0.05).
RESULTS: There were 245 elderly patients with mTBI identified (Table); 64% of patients were admitted to the PCU, with 10 requiring upgrade (6.4%). Those upgraded had higher rates of NSI and mortality (Table). The rate of NSI was significantly higher in patients with GCS¼13, HAIS¼5, or presence of mass effect (33%, 64%, 45%, respectively p0.05 for all). Table 1. Outcomes of Elderly Patients with Mild Traumatic Brain Injury n/group Disposition Overall PCU PCU/ICU upgrade ICU
NSI
Mortality
n
%
Head AIS, mean (SD)
n
%
n
%
245 146
100 59
3.7 (0.75) 3.5 (0.67)
34 1
14 0.7
20 1
8 0.7
10 89
4 36
4.3 (0.67) 4.1 (0.75)
5 28
50.0 31.5
3 16
30.0 18.0
NSI, neurosurgical intervention, PCU, progressive care unit.
CONCLUSIONS: The majority of elderly patients with mTBI and ICH can be safely observed outside ICUs. However, patients requiring escalation (6.4%) in care have a worse outcome. Patients with GCS¼13, HAIS¼5, or presence of mass effect have higher rates of NSI and should be observed in ICUs. New guidelines are needed to optimize outcomes and resource use in this growing population. Outcomes for Emergent Surgical Procedures in Octogenarians: A 7-year experience from the American College of Surgeons National Surgical Quality Improvement Data Busayo B Irojah, MD York Hospital, York, PA INTRODUCTION: Octogenarians represent a small but growing portion of the population. By 2050, it is projected that individuals over the age of 80 will constitute 7.4% of the US population. The purpose of this study was to assess the mortality of select general surgical procedures in octogenarians to guide surgeons in counseling patients. METHODS: Using the ACS NSQIP database (2005-2012), a retrospective analysis was done of 5,016 octogenarians who
CONCLUSIONS: Between 2005 and 2012, the mortality for select general surgical procedures decreased; however, the decrease was not statistically significant. Octogenarians still have a high mortality of about 7%. The mortality for laparoscopic procedures was lower than for open procedures. Mortality in colorectal operations remains significantly higher and needs further investigation. Redefining the Association Between Old Age and Poor Outcomes after Trauma: The Impact of the Frailty Syndrome Tahereh O Jokar, MD, Peter M Rhee, MD, FACS, Bardiya Zangbar, MD, Narong Kulvatunyou, MD, FACS, Mazhar Khalil, MD, Terence O’Keeffe, MB, ChB, FACS, Andrew L Tang, MD, FACS, Randall S Friese, MD, FACS, Lynn M Gries, MD, Bellal Joseph, MD, FACS University of Arizona, Tucson, AZ INTRODUCTION: Frailty syndrome (FS) is a well-established measure of poor outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and determine its association with post-trauma morbidity, trauma readmissions, and 6-month mortality. METHODS: We performed a 2-year prospective cohort analysis of all geriatric (age 65 y) trauma patients. Frailty syndrome was