Abstract
Background: Acute Care Surgery (ACS) is a rapid response system in emergency surgical conditions. Older patients have numerous factors associated with high mortality and morbidity in emergency colorectal surgery. We aimed to identify potentially preventable risk factors, to improve older patients’ outcomes.Methods: A retrospective review of patients over 60 years old undergoing emergency colorectal surgery in the ACS service from 1 August 2017 through 30 November 2019.Results: Data of 92 patients were analyzed, average age 72.41 years. The most common diagnosis was colorectal cancer (76, 83.52%) with locations on the left (37, 41.51%), right (35,39.33%), and rectum (17, 19.10%). Clinical presentations were obstruction without perforation (61, 67.03%), perforation (25, 27.17%), and ischemia (2, 2.17%). Overall mortality was 6.52%. Cause of death included septic shock (3, 50%); respiratory failure (3, 50%); and pulmonary embolism (1, 16.67%). Morbidity from surgical and medical complications were 41.30% and 26.08%, respectively. For all causes, operations included resection with primary anastomosis (62, 71.26%); Hartman procedure (11, 12.64%); loop colostomy (12, 13.79%); and percutaneous drainage with antibiotics (2, 2.3%). Average operative time 159.86 minutes. In emergency colorectal surgery, preexisting heart disease, clinical perforation, and ventilator dependency increased risk of death 7.6-, 16.5-, and 0.08-fold, respectively.Conclusion: Preexisting heart disease and clinical perforation were unmodifiable risk factors for mortality among older patients undergoing emergency colorectal surgery; ventilator dependency is potentially modifiable with advanced surgical critical care. Early, rapid, protocol-driven processes might help reduce mortality in patients with clinical presentation of perforation.
Laparoscopic cholecystectomy in the Acute Care Surgery model: risk factors for complications
