Emergency surgery in older patients.

INTRODUCTION: At present, emergency guidelines do not differentiate between younger adults and older persons. The changing socioeconomic situation associated with the aging population will be challenging for the healthcare system and requires new medical guidelines to best accommodate it. AIM: To analyze whether the age and comorbidities of a patient affect acute care surgical outcomes. MATERIAL AND METHODS: We performed a retrospective study of 161 patients who were admitted in emergency to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn between May and October 2017. Patients were divided into three age groups. Outcomes in patients older than 80 years were compared with corresponding statistical predictions of morbidity and mortality, as calculated using the Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM). RESULTS: Patients in the 80+ age group had a higher mortality rate in comparison with those in the other age groups, and a higher number of comorbidities (p = 0.002 and p = 0.001, respectively). The POSSUM morbidity and mortality rates were significantly higher for the older patients who died than for the older patients who were discharged (p = 0.013 and p = 0.003, respectively). CONCLUSIONS: Decisions about suitable therapy in the acute care setting should be made after consideration of the overall health of a patient. This study shows that age itself has a huge impact on postoperative results. The older the patient is, the higher the risk of perioperative death. We recommend patient evaluation using the POSSUM scale to better predict this risk.

Surgical treatment of acute appendicitis in older patients.

INTRODUCTION: Acute appendicitis (AA) is the most common indication for emergency surgery and it occurs more often in children and young adults than in patients of advanced age. AA in older patients is a challenging surgical problem because of its atypical presentation. This study was performed to determine whether the age of a patient impacts the outcomes and whether laparoscopic appendectomy (LA) is a feasible method for treatment of patients > 65 years. MATERIAL AND METHODS: We performed a retrospective study of 355 patients with AA who were admitted to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn from 2014 to 2017. The patients were divided into three age groups: 18 to 40, 41 to 65 and >65 years. The histopathological diagnoses were divided into three types: simple AA, phlegmonous AA, and gangrenous AA. RESULTS: LA was performed in 96% of young adults and in 67% of older patients. The patients older than 65 years had higher preoperative white blood cell counts, higher C-reactive protein (CRP) levels and had a longer length of stay (LOS) than younger patients (P=0.05, P=0.03, and P=0.03, respectively). We found a positive correlation among the CRP levels, open appendectomy (OA), and gangrenous appendicitis. CONCLUSIONS: Patients older than 65 years more frequently underwent OA than LA, had higher preoperative CRP levels and had a longer LOS than younger patients. Higher CRP levels were associated with a greater risk of gangrenous appendicitis. LA is a safe and feasible treatment method for patients older than 65 years.