The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

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RESEARCH PRODUCT

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Gianluca Costa Pietro Fransvea Mauro Podda Adolfo Pisanu Francesco Maria Carrano Angelo Iossa Genoveffa Balducci Agresta F Ferdinando Collaborative Study Group: Agresta G Alemanno G Anania M Antropoli G Argenio J Atzeni N Avenia A Azzinnaro G Baldazzi G Balducci G Barbera G Bellanova C Bergamini L Bersigotti Pp Bianchi C Bombardini G Borzellino S Bozzo G Brachini Gm Buonanno T Canini S Cardella G Carrara D Cassini M Castriconi G Ceccarelli D Celi M Ceresoli M Chiarugi N Cillara F Cimino L Cobuccio G Cocorullo E Colangelo G Costa A Crucitti P Dalla Caneva M De Luca A De Manzoni Garberini C De Nisco M De Prizio A De Sol A Dibella T Falcioni N Falco C Farina E Finotti T Fontana G Francioni P Fransvea B Frezza G Garulli M Genna S Giannessi A Gioffrè A Giordano D Gozzo S Grimaldi G Gulotta V Iacopini T Iarussi E Laterza A Leonardi L Lepre L Lorenzon G Luridiana A Malagnino G Mar P Marini R Marzaioli G Massa V Mecarelli A Mingoli G Nigri S Occhionorelli N Paderno Gm Palini D Paradies M Paroli F Perrone L Petruzzelli A Pezzolla D Piazza V Piazza M Piccoli A Pisanu M Podda G Poillucci R Porfidia G Rossi P Ruscelli A Spagnoli R Sulis D Tartaglia C Tranà A Travaglino P Tomaiuolo A Valeri G Vasquez M Zago E. Zanoni

subject

Male Settore MED/18 - CHIRURGIA GENERALE Endoscopy Gastrointestinal Cohort Studies 0302 clinical medicine Postoperative Complications Elderly Abdomen 80 and over Medicine Prospective Studies Prospective cohort study Laparoscopy Abdomen Acute Aged 80 and over medicine.diagnostic_test Mortality rate Age Factors Prognosis Multicenter study Italy Acute abdomen 030220 oncology & carcinogenesis Emergency surgery 030211 gastroenterology & hepatology Female medicine.symptom Cohort study Risk Gastrointestinal medicine.medical_specialty Acute Malignancy NO Acute abdomen 03 medical and health sciences Emergency surgery Humans Aged business.industry acute abdomen; elderly; emergency surgery; laparoscopy; multicenter study Endoscopy medicine.disease Surgery Surgery Laparoscopy Emergencies Morbidity business Procedures and Techniques Utilization Abdominal surgery

description

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

year	journal	country	edition	language
2020-01-01

10.1007/s13304-020-00726-5 http://hdl.handle.net/10447/408981