FACTORS INFLUENCING MORTALITY AND MORBIDITY IN ELDERLY POPULATION UNDERGOING VARIOUS ELECTIVE/ EMERGENCY SURGICAL PROCEDURE
Main Article Content
Keywords
Elderly, Emergency or Elective Surgery, Morbidity, Mortality
Abstract
Aim: The purpose of the study is to determine various aspects that affect the outcome of elderly
patients undergoing various surgical procedures in the surgery department.
Place and Duration: In the Surgical department of, PIMS Hospital, Islamabad for two-year duration
from January 2021 to December 2022
Methods: This is a retrospective, descriptive analysis of all patients 60 years of age and older (n=200)
who underwent elective or emergency surgical procedures. One of the co-authors was given authority
for collecting all patient records aged over 60 who underwent various surgical procedures. To
investigate common comorbidities in elderly patients and their impact on overall surgical outcomes,
all patient records were studied and data was recorded on a proforma. The data was statistically
analyzed with SPSS version 21.0.
Results: 200 patients aged >60 years admitted for emergency or elective general surgery were
included in this study. The patients mean age was 65.8 years, mean BMI was 26.1 kg/m2, and 70%
of the participants were men. In elderly patients, 85% had comorbidities. In this study, 85.5% of
patients used minimum one medication at home before hospitalization. The Hernia repair (20.5%),
Resection of the colon (22.5%), resection of the small intestine (19%) or Cholecystectomy (17%)
were the most common elective or emergency procedures of general surgery, followed by laparotomy
(9%). The most common complication (6% of patients) were pulmonary in nature and included
pneumonia, pulmonary embolism, and respiratory failure (requiring treatment in the intensive care
unit). In total, 30 very elderly patients who required emergency surgery died in the hospital (mortality
15%).
Conclusions: In conclusion, mortality among elderly adult patients undergoing urgent hernia surgery
is high. Surgery remains difficult for the elderly due to coexisting health problems. This is an early
planned hernia repair that is highly recommended.
References
2. Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clinical interventions in aging. 2018 Jan 24:143-50.
3. De Jong L, Klem TM, Kuijper TM, Roukema GR. Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. The bone & joint journal. 2017 Aug;99(8):1088-94.
4. Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC pregnancy and childbirth. 2017 Dec;17(1):1-4.
5. Manyisa ZM, van Aswegen EJ. Factors affecting working conditions in public hospitals: A literature review. International journal of Africa nursing sciences. 2017 Jan 1;6:28-38.
6. Rencuzogullari A, Benlice C, Valente M, Abbas MA, Remzi FH, Gorgun E. Predictors of anastomotic leak in elderly patients after colectomy: nomogram-based assessment from the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort. Diseases of the Colon & Rectum. 2017 May 1;60(5):527-36.
7. Benjamin B. Social and economic factors affecting mortality. InSocial and economic factors affecting mortality 2018 Dec 3. De Gruyter Mouton.
8. McMaughan DJ, Oloruntoba O, Smith ML. Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Frontiers in public health. 2020 Jun 18;8:231.
9. Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics. 2018 Dec;18(1):1-1.
10. Flaatten H, De Lange DW, Artigas A, Bin D, Moreno R, Christensen S, Joynt GM, Bagshaw SM, Sprung CL, Benoit D, Soares M. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive care medicine. 2017 Sep;43:1319-28.
11. Latunji OO, Akinyemi OO. Factors influencing health-seeking behaviour among civil servants in Ibadan, Nigeria. Annals of Ibadan postgraduate medicine. 2018 Jul 17;16(1):52-60.
12. Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, Ricceri F, d'Errico A, Barros H, Bochud M, Chadeau-Hyam M. Socioeconomic status and the 25× 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1· 7 million men and women. The Lancet. 2017 Mar 25;389(10075):1229-37.
13. Alawieh A, Zhao J, Feng W. Factors affecting post-stroke motor recovery: implications on neurotherapy after brain injury. Behavioural brain research. 2018 Mar 15;340:94-101.
14. Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public health. 2019 Mar 1;168:92-101.
15. Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC musculoskeletal disorders. 2019 Dec;20(1):1-9.
16. Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. Journal of the American Medical Directors Association. 2020 Feb 1;21(2):181-7.
17. Soto-Perez-de-Celis E, Li D, Yuan Y, Lau YM, Hurria A. Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. The Lancet Oncology. 2018 Jun 1;19(6):e305-16.
18. Martín S, Pérez A, Aldecoa C. Sepsis and immunosenescence in the elderly patient: a review. Frontiers in medicine. 2017 Feb 28;4:20.
19. Folbert EC, Hegeman JH, Gierveld R, Van Netten JJ, Velde DV, Ten Duis HJ, Slaets JP. Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Archives of orthopaedic and trauma surgery. 2017 Apr;137:507-15.
20. Fonteyne V, Ost P, Bellmunt J, Droz JP, Mongiat-Artus P, Inman B, Paillaud E, Saad F, Ploussard G. Curative treatment for muscle invasive bladder cancer in elderly patients: a systematic review. European Urology. 2018 Jan 1;73(1):40-50.
21. Guaraldi G, Malagoli A, Calcagno A, Mussi C, Celesia BM, Carli F, Piconi S, De Socio GV, Cattelan AM, Orofino G, Riva A. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65–74 years and more than 75 years. BMC geriatrics. 2018 Dec;18:1-0.
22. Veronese N, Stubbs B, Noale M, Solmi M, Pilotto A, Vaona A, Demurtas J, Mueller C, Huntley J, Crepaldi G, Maggi S. Polypharmacy is associated with higher frailty risk in older people: an 8-year longitudinal cohort study. Journal of the American Medical Directors Association. 2017 Jul 1;18(7):624-8.
23. Connolly D, Garvey J, McKee G. Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA). Disability and rehabilitation. 2017 Apr 10;39(8):809-16.
24. Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, Canin B, Cohen HJ, Holmes HM, Hopkins JO, Janelsins MC. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. Journal of Clinical Oncology. 2018 Aug 8;36(22):2326.
25. Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell IS, Pearce L, Moug SJ, ELF Study Group. Frailty in older patients undergoing emergency laparotomy: results from the UK observational emergency laparotomy and frailty (ELF) study. Annals of surgery. 2021 Apr 1;273(4):709-18.
26. Zhang Y, Chen Y, Ma L. Depression and cardiovascular disease in elderly: Current understanding. Journal of Clinical Neuroscience. 2018 Jan 1;47:1-5.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Hannan Sajid
PGR G. Surgery, PIMS Hospital, Islamabad
Dr. Muhammad Aqib
PGR G. Surgery, PIMS Hospital, Islamabad
Dr. Rabia Irfan
PGR Gynae, PIMS Hospital, Islamabad
Dr. Hassaan Sajid
PGR G. Surgery, POF Hospital, Wah Cantt
Dr Zakir Jamal
PGR G. Surgery, PIMS hospital, Islamabad
Dr Ayesha Rehab
PGR ENT, PAF Hospital, Islamabad