Geriatric patients remain largely unstudied in low-middle income health care settings. The purpose of this study was to compare the epidemiology and outcomes of older versus younger adults with emergency general surgical conditions in South Asia.
Discharge data from March 2009 to April 2014 were obtained for all adult patients (≥16 years) with an International Classification of Diseases, 9th revision, Clinical Modification diagnosis codes consistent with an emergency general surgery condition as defined by the American Association for the Surgery of Trauma. Multivariable regression analyses compared patients >65 years of age with patients ≤65 years for differences in all-cause mortality, major complications, and duration of hospital stay. Models were adjusted for potential confounding owing to patient demographic and clinical case-mix data with propensity scores.
We included 13,893 patients; patients >65 years constituted 15% (n = 2,123) of the cohort. Relative to younger patients, older adults were more likely to present with a number of emergency general surgery conditions, including gastrointestinal bleeding (odds ratio OR [95% CI], 2.63[1.99–3.46]), resuscitation (2.17 [1.67–2.80]), and peptic ulcer disease (2.09 [1.40–3.10]). They had an 89% greater risk-adjusted odds (1.89 [1.55–2.29]) of complications and a 63% greater odds (1.63 [1.21–2.20]) of mortality. Restricted to patients undergoing operative interventions, older adults had 95% greater odds (1.95 [1.29–2.94]) of complications and 117% greater odds (2.17 [1.62–2.91]) of mortality.
Understanding unique needs of geriatric patients is critical to enhancing the management and prioritization of appropriate care in developing settings.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
The World Bank. Life expectancy at birth, total (years) [updated 2015]. Available from: http://data.worldbank.org/indicator/SP.DYN.LE00.IN. Accessed January 1, 2015.
- Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study.Eur J Clin Pharmacol. 2011; 67: 507-519
- World population ageing.United Nations, Geneva2013
- Ageing in Pakistan—a new challenge.Ageing Int. 2011; 36: 423-427
- Surgical problems in the aged.John Wright & Sons, Bristol, UK1979
- American College of Surgeons: Socio-economic factbook for surgery 1990.American College of Surgeons, Chicago1990
- The impact of frailty in the elderly on the outcome of surgery in the aged.Adv Surg. 2010; 44: 229-249
- Perioperative care of the elderly patient.World J Surg. 1993; 17: 192-198
- Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg. 2010; 210: 901-908
- The aging population and its impact on the surgery workforce.Ann Surg. 2003; 238: 170-177
- Emergency general surgery: definition and estimated burden of disease.J Trauma Acute Care Surg. 2013; 74: 1092-1097
- The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample–2001 to 2010.J Trauma Acute Care Surg. 2014; 77: 202-208
- Maximum parsimony or haplotyping by sparse dictionary selection.BMC Genomics. 2013; 14: 645
- Adolescent and young adult oncology: an emerging field.J Clin Oncol. 2010; 28: 4781-4782
- Clinical pharmacology in the adolescent oncology patient.J Clin Oncol. 2010; 28: 4790-4799
- Delineating the age ranges used to define adolescents and young adults.J Clin Oncol. 2011; 29: e492-e493
- Practical considerations on the use of the Charlson comorbidity index with administrative data bases.J Clin Epidemiol. 1996; 49: 1429-1433
- Risk adjustment in outcome assessment: the Charlson comorbidity index.Methods Inf Med. 1993; 32: 382-387
- The attributable mortality and length of stay of trauma-related complications: a matched cohort study.Ann Surg. 2010; 252: 358-362
- Specialized care for elderly patients.N Engl J Med. 2002; 346: 874
- Quality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional study.World J Emerg Surg. 2013; 8: 23
- Evaluation of results of surgical procedures in the elderly.Ann Surg. 1982; 195: 90-96
- Inpatient surgery in California: 1990-2000.Arch Surg. 2003; 138: 1106-1111
- Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults.Am J Surg. 2011; 202: 511-514
- Factors influencing morbidity and mortality in elderly population undergoing inguinal hernia surgery.J Pak Med Assoc. 2010; 60: 45-47
- The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India.J Assoc Physicians India. 2010; 58: 15-19
- Impact of age on outcome after colorectal cancer surgery in the elderly - a developing country perspective.BMC Surg. 2011; 11: 17
- A call to action–integration of geriatrics into mainstream medicine.J Pak Med Assoc. 2014; 64: 3-4
- Polypharmacy in elderly: a cautious trail to tread.J Pak Med Assoc. 2013; 63: 624-627
Published online: May 18, 2015
Accepted: March 31, 2015
Conflicts of Interest: None to declare.
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.