scholarly journals Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review

Author(s):  
James M. Halle-Smith ◽  
David N. Naumann ◽  
Susan L. Powell ◽  
Laura K. Naumann ◽  
Ewen A. Griffiths

Abstract Purpose of Review The aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes. Recent Findings Preoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote return to function. Summary This review of contemporary evidence identifies multiple pre-, peri- and postoperative interventions that can improve outcomes for elderly patients after emergency general surgery. These evidence-based recommendations should help direct care of elderly patients undergoing emergency surgery and foster further quality improvement measures and research investigations.

2020 ◽  
Vol 220 (4) ◽  
pp. 1052-1057 ◽  
Author(s):  
Apostolos Gaitanidis ◽  
Sarah Mikdad ◽  
Kerry Breen ◽  
Napaporn Kongkaewpaisan ◽  
April Mendoza ◽  
...  

2014 ◽  
Vol 219 (3) ◽  
pp. S53-S54 ◽  
Author(s):  
Bellal Joseph ◽  
Viraj Pandit ◽  
Bardiya Zangbar ◽  
Narong Kulvatunyou ◽  
Andrew L. Tang ◽  
...  

Author(s):  
Gianluca Costa ◽  
◽  
Laura Bersigotti ◽  
Giulia Massa ◽  
Luca Lepre ◽  
...  

Abstract Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.


2016 ◽  
Vol 223 (4) ◽  
pp. S59-S60
Author(s):  
Gilgamesh Eamer ◽  
Fiona Clement ◽  
Jenelle L. Pederson ◽  
Thomas A. Churchill ◽  
Rachel G. Khadaroo

2018 ◽  
Vol 22 (4) ◽  
pp. 767-768
Author(s):  
Arianna Birindelli ◽  
R. Justin Davies ◽  
Gregorio Tugnoli ◽  
Fausto Catena ◽  
Salomone Di Saverio

2011 ◽  
Vol 212 (6) ◽  
pp. 1039-1048 ◽  
Author(s):  
Angela M. Ingraham ◽  
Mark E. Cohen ◽  
Mehul V. Raval ◽  
Clifford Y. Ko ◽  
Avery B. Nathens

2017 ◽  
Vol 117 (6) ◽  
pp. 370-375 ◽  
Author(s):  
Jens Goeteyn ◽  
Louis A. Evans ◽  
Siem De Cleyn ◽  
Sigrid Fauconnier ◽  
Caroline Damen ◽  
...  

2018 ◽  
Vol 227 (4) ◽  
pp. e146
Author(s):  
Bardiya Zangbar ◽  
Leon Boudourakis ◽  
Natalya Chernichenko ◽  
Daniel J. Gross ◽  
Tim Schwartz ◽  
...  

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