Nonagenarian Surgical Admissions for the acute abdomen: Who benefits?

Zaher Toumi (1) , Annabel Kesterton (2) , Arnab Bhowmick (3) , Alan Beveridge (3) , Nigel A. Scott (4)

1 General Surgery
2 General Surgery
3 Colorectal Surgery
4 Colorectal Surgery

Introduction Patients 90 years and older, form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. Methods and Materials Surgical management of 49 consecutive nonagenarian admissions (median age 92yrs) with an acute abdomen compared to the management and outcome of 50 younger patients (median age 53.5) admitted with a suspected acute abdomen over the same period. Results Nonagenarian group were mainly female (71% v 50% p=0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients – although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% v 24%). Of the 49 nonagenarian patients admitted, only 4% (n=2) were operated on. By contrast, 38% (n=19) of patients aged 50-59 (P=0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50-59 comparator group (16% nonagenarians versus 4% comparator patients; p=0.04). The very large majority of survivors in both age groups were discharged back to their pre-admission domicile (39 (95%) nonagenarians versus 46 (96%) comparator 50-59 year group). Conclusions In this study, when compared with younger patients very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead the large majority of nonagenarians either died or were discharged back to their home address without surgery.

Mots clés: Medicine

Zaher Toumi, Annabel Kesterton, Arnab Bhowmick, Alan Beveridge, Nigel A. Scott. Nonagenarian Surgical Admissions for the acute abdomen: Who benefits?. International Journal of Clinical Practice, 2010, 64 (11), pp.1570. ⟨10.1111/j.1742-1241.2010.02468.x⟩. ⟨hal-00576625⟩