scholarly journals Discharge outcomes among elderly patients undergoing emergency abdominal surgery: registry study of discharge data from Irish public hospitals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Aisling McCann ◽  
Jan Sorensen ◽  
Deirdre Nally ◽  
Dara Kavanagh ◽  
Deborah A. McNamara
Keyword(s):  
Abdominal Surgery ◽  
Elderly Patients ◽  
Public Hospitals ◽  
Registry Study ◽  
Discharge Data ◽  
Discharge Outcomes ◽  
Emergency Abdominal Surgery

Sarcopenia predicts 90-day mortality in elderly patients undergoing emergency abdominal surgery

2019 ◽  
Vol 44 (3) ◽  
pp. 1155-1160 ◽  
Author(s):  
Erik Brandt ◽  
Line Toft Tengberg ◽  
Morten Bay-Nielsen
Keyword(s):  
Abdominal Surgery ◽  
Elderly Patients ◽  
Emergency Abdominal Surgery

Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery

2017 ◽  
Vol 83 (6) ◽  
pp. 1179-1186 ◽  
Author(s):  
Erika L. Rangel ◽  
Arturo J. Rios-Diaz ◽  
Jennifer W. Uyeda ◽  
Manuel Castillo-Angeles ◽  
Zara Cooper ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Elderly Patients ◽  
Emergency Abdominal Surgery ◽  
Long Term Mortality

scholarly journals Variation in Hospital Length of Stay Based on Hospital Volume: A Retrospective Cohort Study of Emergency Abdominal Surgery in Ireland

2019 ◽  
pp. 1-6
Author(s):  
Jan Sorensen ◽  
Dara Kavanagh ◽  
Deirdre Nally ◽  
Gintare Valentelyte ◽  
Jan Sorensen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Hospital Volume ◽  
High Volume ◽  
Hospital Length ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Low Volume ◽  
Emergency Abdominal Surgery

Objectives: Emergency abdominal surgery (EAS) refers to high risk intra-abdominal surgical procedures associated with increased mortality risk and long length of hospital stay. The variation between hospital volume and hospital length of stay (LOS) of patients undergoing EAS is poorly understood. Our objective was to explore this relationship across public hospitals in Ireland. Methods: Data for all adult episode discharges from public Irish hospitals in 2014-2017 were obtained from National Quality Assurance Improvement System (NQAIS) Clinical with EAS identified by primary procedure codes. Hospitals were categorised into low (n<200), medium (n=200-400), and high (n>400) volume groups based on the number of EAS episodes during the study period. Negative binomial regression models were applied to standardise for patient case mix. Several adjusted LOS measures were compared across the three volume groups. Sensitivity analysis was conducted to test the robustness of our findings. Results: 8120 hospital episodes across 24 public hospitals providing EAS services were analysed. 7 were categorised as low, 9 as medium, and 8 as high-volume hospitals. High volume hospitals had a significantly longer adjusted LOS (24.7 days) relative to low and medium volume hospitals (18.2 and 18.6 days). Sensitivity analysis consisted of the exclusion of the following hospital episodes: in-hospital death, cancer diagnosis, Charlson comorbidity index (CCI) >0, admission from other hospitals, and discharge to other hospitals. No single variable influenced the observed LOS variation, although when the more complex episodes were excluded, the post-operative LOS at low and medium volume hospitals was significantly shorter compared to high volume hospitals (by 1.1-6.1 days). Intensive care unit (ICU) LOS was similar in all three hospital volume groups although low volume hospitals appeared to have more ICU admissions and longer stay (by up to 1.6 days). Conclusions: Our findings indicate that patients treated at low volume hospitals have shorter LOS and may be discharged earlier than from high volume hospitals. This finding is surprising, suggesting that concentration of services to larger clinical departments may not necessarily reduce LOS and improve the efficiency of resource utilisation and service delivery.

scholarly journals Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hwee Leong Tan ◽  
Shermain Theng Xin Chia ◽  
Nivedita Vikas Nadkarni ◽  
Shin Yuh Ang ◽  
Dennis Chuen Chai Seow ◽  
...  
Keyword(s):  
Cohort Study ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
The Elderly ◽  
Functional Independence ◽  
Surgery In The Elderly ◽  
The Impact ◽  
Emergency Abdominal Surgery

Abstract Background Frailty has been associated with an increased risk of adverse postoperative outcomes in elderly patients. We examined the impact of preoperative frailty on loss of functional independence following emergency abdominal surgery in the elderly. Methods This prospective cohort study was performed at a tertiary hospital, enrolling patients 65 years of age and above who underwent emergency abdominal surgery from June 2016 to February 2018. Premorbid variables, perioperative characteristics and outcomes were collected. Two frailty measures were compared in this study—the Modified Fried’s Frailty Criteria (mFFC) and Modified Frailty Index-11 (mFI-11). Patients were followed-up for 1 year. Results A total of 109 patients were prospectively recruited. At baseline, 101 (92.7%) were functionally independent, of whom seven (6.9%) had loss of independence at 1 year; 28 (25.7%) and 81 (74.3%) patients were frail and non-frail (by mFFC) respectively. On univariate analysis, age, Charlson Comorbidity Index and frailty (mFFC) (univariate OR 13.00, 95% CI 2.21–76.63, p < 0.01) were significantly associated with loss of functional independence at 1 year. However, frailty, as assessed by mFI-11, showed a weaker correlation than mFFC (univariate OR 4.42, 95% CI 0.84–23.12, p = 0.06). On multivariable analysis, only premorbid frailty (by mFFC) remained statistically significant (OR 15.63, 95% CI 2.12–111.11, p < 0.01). Conclusions The mFFC is useful for frailty screening amongst elderly patients undergoing emergency abdominal surgery and is a predictor for loss of functional independence at 1 year. Including the risk of loss of functional independence in perioperative discussions with patients and caregivers is important for patient-centric emergency surgical care. Early recognition of this at-risk group could help with discharge planning and priority for post-discharge support should be considered.

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