• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (14)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Oncology  • Colon Cancer  • Surgery  • Surgical Interventions  • Colorectal Surgery  • Prognosis/ Outcomes  • Emergency Medicine  • Gastroenterology  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Edward A. McGillicuddy, MD; Kevin M. Schuster, MD; Kimberly A. Davis, MD; Walter E. Longo, MD

Arch Surg. 2009;144(12):1157-1162.

Objective  To identify rapidly modifiable risk factors that would improve surgical outcomes in elderly patients undergoing emergent colorectal procedures who are at high risk for morbidity and mortality.

Design  Retrospective review. Patients were identified on the basis of Current Procedural Terminology codes and admission through the emergency department. Medical records were reviewed and data were abstracted for comorbidities, procedural details, and in-hospital morbidity and mortality.

Setting  University tertiary referral center.

Patients  Two hundred ninety-two patients 65 years or older undergoing emergency colorectal procedures from January 1, 2000, through December 31, 2006.

Main Outcome Measures  Postoperative morbidity (intensive care unit days, ventilator days, pneumonia, deep venous thrombosis, pulmonary embolus, myocardial infarction, and cerebrovascular accident) and mortality.

Results  The most frequent presenting diagnoses were obstructing or perforated colorectal carcinoma (30%) and perforated diverticulitis (25%). Average age at presentation was 78.1 years, and in-hospital mortality was 15%. One hundred one patients (35%) experienced a total of 195 complications. Pneumonia (25%), persistent or recurrent respiratory failure (15%), and myocardial infarction (12%) were the most frequent complications. Operative time, shock, renal insufficiency, and significant intra-abdominal contamination or frank peritonitis were associated with morbidity. Age, septic shock at presentation, large estimated intraoperative blood loss, delay to operation, and development of a complication were associated with in-hospital mortality.

Conclusions  Emergent colorectal procedures in the elderly are associated with significant morbidity and mortality. Minimizing the delay to definitive operative care may improve outcomes. These procedures frequently involve locally advanced colorectal cancer, emphasizing the need for improved colorectal cancer screening.

Author Affiliations: Section of Trauma, Surgical Critical Care, and Surgical Emergencies (Drs Schuster and Davis), Department of Surgery (Drs McGillicuddy and Longo), Yale University School of Medicine, New Haven, Connecticut.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Ventilator-Associated Pneumonia and Septic Shock in Emergency Colorectal Procedures in Elderly Patients
Silvio A. Ñamendys-Silva, Marisol Hernández-Garay, Eduardo Rivero-Sigarroa, and Angel Herrera-Gómez
Arch Surg. 2010;145(6):602.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Getting Old Shouldn't Be an Emergency: Comment on "Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients"
James W. Fleshman
Arch Surg. 2009;144(12):1162.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ventilator-Associated Pneumonia and Septic Shock in Emergency Colorectal Procedures in Elderly Patients
Namendys-Silva et al.
Arch Surg 2010;145:602-602.
FULL TEXT