2008 Annual Meeting Abstracts
Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in the Elderly
Edward A. McGillicuddy, MD, Kevin M. Schuster, MD, Kimberly A. Davis, MD, Walter E. Longo, MD.
Yale University School of Medicine; Yale New-Haven Hospital, New Haven, CT, USA.
Objective: With the aging of the population, emergency colorectal procedures in the elderly are becoming more common. The outcomes, including morbidity and mortality, of elderly patients undergoing emergent colorectal procedures are not well described.
Design: We identified a cohort of patients over 65 years old undergoing emergency colorectal procedures from 2000-2006. These patients were identified based on CPT codes and admission through the emergency department. Charts were reviewed and data abstracted for comorbidities, procedural details, and in-hospital morbidity and mortality. Univariate and multivariate analysis was performed with logistic regression to identify factors impacting morbidity and mortality.
Setting: Urban, academic, tertiary care institution
Patients: One-hundred and two patient charts were reviewed
Main Outcome Measures: Morbidity and mortality
Results: The most frequent presenting diagnoses were perforated diverticulitis (34%) and obstructing or perforated colorectal carcinoma (24%). The overall in-hospital mortality was 12.7%, and the average length of stay was 18.5 days. Forty-three patients experienced a total of 54 complications; pneumonia (25.4%) was the most frequent complication. On multivariate analysis, American Society of Anesthesiologists classification (ASA score) (OR 3.38, 95% CI 1.36-8.38, p=0.009), estimated intraoperative blood loss (EBL) (OR 1.003, 95% CI 1.0 - 1.01, p=0.023), and either pre-existent or operatively diagnosed malignant disease (OR 3.38, 95% CI 1.09-10.46, p=0.035) were associated with an increased incidence of post-operative complications. ASA status was also predictive of post-operative mortality (OR 6.56, 95% CI 1.79-25.1, p=0.005).
Conclusions: Emergent colorectal procedures in the elderly are associated with significant morbidity and mortality when compared with elective procedures. High preoperative ASA score, significant EBL, and malignancy are associated with complications while increased ASA score is associated with mortality.