Outcome of emergency abdominal surgery in elderly patients

The outcome of emergency abdominal surgery in elderly patients [above 60 years old] remains unsatisfactory. Factors contributing to this outcome were studied; particularly in those aged 80 years and older. 44 patients aged 80 years or more [group A] and 152 patients aged 60-79 years [group B] who underwent emergency abdominal surgery between 1998 and 2003 in El-Minia University hospital and Al Haram hospital. Complications were significantly higher in group A than in group B. Respiratory failure was the most common postoperative complication. The mortality rate within 30 days after operation was also higher in group A[23%] than in group B [4.5%]. Morbidity and mortality did not differ significantly between those with and without preexisting concomitant disease in group A. Group B showed significant difference in morbidity and mortality among those Patients with or without preexisting concomitant disease Systemic Inflammatory Respouse Syndrome [SIRS]was noted in 26 patients [59%]in group A and in 71 patients [47%]in group B. Severe complications occurred in 22 patients [50%] of group A with Preoperative SIRS. The mortality rate in those with SIRS was significantly higher than that in patients without. So SIRS is considered a predictor of poor outcome in elderly patients who have emergency abdominal surgery. We concluded that Patients with SIRS should initially receive minimal treatment whenever possible, rather' than be over treated, until their condition stabilizes

Removal of huge spleen: a surgical risk? its morbidity and mortality

Reports vary about whether risks are greater for removal of huge [>1500g] spleens than for smaller [<1500g] spleens. Splenectomy was performed on 196 patients presented with massive splenomegaly [n=83] and smaller splenomegaly [n=113]. Patients with huge spleens are no more likely to have postoperative complications [relative risk [RR] 2.2 95% confidence interval [Cl] 1.5 to3.1; p=0.7] and death [RR, 4, 3; 95% Cl, 1.4 to 12.2; p=0.3]. When the investigation is restricted to comparable diagnoses [congestive splenomegaly], patients with huge spleens do not differ from those with smaller spleens regarding complications [RR 1.3; 95% Cl 0.9 to 2.8; p=0.2] and death [RR2.1; Cl 0.9 to 8.2; p=0.3]. Multivariate analysis accused age as a critical risk of complications and death. This series concluded that increased age and underlying illness are the predominant factors associated with morbidity and mortality following splenectomy for congestive and hematological massive splenomegally. Adjusting for age and diagnosis, spleen size is not a hazard