Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis

doi:10.1016/j.surg.2012.06.038

Surgery

Volume 152, Issue 3, September 2012, Pages 465-472

Presented at the 7th Annual Academic Surgical Congress, February 16th, 2012, Las Vegas, NV.

https://doi.org/10.1016/j.surg.2012.06.038 Get rights and content

Background

The objectives of our study were to determine the association between age and postoperative outcomes after emergency surgery for diverticulitis and to identify risk factors for postoperative mortality among elderly patients.

Methods

All patients from the American College of Surgeons National Surgical Quality Improvement Program 2005–2009 Participant User Files undergoing emergent surgery for diverticulitis were included. Multivariate logistic regression was used to determine the association between age and postoperative morbidity and mortality after adjustment for perioperative variables. A separate regression model was used to determine risk factors for postoperative mortality among elderly patients, with specific postoperative complications being included as potential predictors.

Results

We included 2,264 patients for analysis, of whom 1,267 (56%) were <65 years old (nonelderly), 648 (28.6%) were 65–79 years old (elderly), and 349 (15.4%) were ≥80 years old (super-elderly). Advanced age was a significant predictor of 30-day postoperative mortality, and to a lesser extent postoperative morbidity. Among those patients ≥65 years old, super-elderly age classification remained a significant predictor of mortality after adjustment for the presence or absence of postoperative complications. Mortality among elderly and super-elderly patients was greatest in the setting of specific complications, such as septic shock, prolonged postoperative mechanical ventilation, and acute renal failure.

Conclusion

Advanced age is an independent risk factor for death after emergency surgery for diverticulitis, with mortality being greatest among elderly patients who experience certain postoperative complications. Prevention of these complications should form the cornerstone of initiatives designed to lower the mortality associated with emergency surgery in elderly patients.

Section snippets

Methods

Patients from the 2005 through 2009 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User File were included in this analysis if they (1) had a postoperative diagnosis of diverticulitis (International Classification of Disease 9th Version code of 562.11 or 562.13) and underwent an emergency operative procedure. Patients undergoing a prior operation within 30 days of the index procedure were excluded from analysis. The primary predictor variable

Results

A total of 2,264 patients undergoing an emergent operation for diverticulitis were identified and included in the analysis, of whom 1,267 (56%) were nonelderly, 648 (28.6%) were elderly, and 349 (15.4%) were super-elderly. The pre- and intraoperative characteristics of patients in each age group are shown in Table I. On univariate analysis, elderly and super-elderly patients were more likely to be female, Caucasian, and to maintain an element of malnutrition than nonelderly patients. They also

Discussion

Our analysis of 2,264 patients undergoing emergency surgery for diverticulitis demonstrates that advancing patient age is independently associated with 30-day postoperative mortality, even after adjustment for preoperative and intraoperative patient- and procedure-related variables. Specifically, we have found that patients aged 65–79 years have a 4-fold, and patients aged ≥80 years a 10-fold greater odds of postoperative death than nonelderly patients. Conversely, we have shown that the effect

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Urgent and emergent procedures have previously been shown to increase the perioperative rate of stroke or death after transfemoral CAS by fivefold in the general population.17 We found an even higher risk of poor outcomes after emergent CAS procedures in our study (OR, 16.7), which may reflect the fact that older patients tend to do worse than younger patients after emergent procedures.19-21 It was surprising that only 70% of patients underwent CAS with an embolic protection device, given that use of an embolic protection device during transfemoral CAS is well supported15,16,18 and has been shown to lower minor and major periprocedural stroke events by 3.2% and 0.8%, respectively.18
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Society of University SurgeonsAdvanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Gastrointest Surg

J Am Coll Surg

Surgery

J Am Coll Surg

Am J Surg

J Surg Res

J Am Coll Surg

J Am Coll Surg

Acute diverticulitis

N Engl J Med

Practice parameters for sigmoid diverticulitis. The Standards Task Force American Society of Colon and Rectal Surgeons

Dis Colon Rectum

United States Census 2010

Epidemiology and management of diverticular disease of the colon

Drugs Aging

Abdominal surgery in nonagenarians: short-term results

Surg Today

Colorectal cancer in nonagenarians

Colorectal Dis

Society of University Surgeons
Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis