Journal Review in Emergency General Surgery: EGS in Patients > 65

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 31 March 2022

⏱️ 29 minutes

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Summary

Join our Emergency General Surgery Team as they discuss EGS in patients > 65.

Introduction
- > 65 = 40% of EGS admissions
- In-hospital mortality for EGS in older adults is approximately 7-12% and the one-year mortality is around 30-38%.
- High risk due to decreased reserve, poor nutritional status, and chronic medical conditions
- Frailty correlates with poor post-operative outcomes

Paper #1: Mehta A, Dultz LA, Joseph B, Canner JK, Stevens K, Jones C, Haut ER, Efron DT, Sakran JV. Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. J Trauma Acute Care Surg. 2018 Jun;84(6):864-875.

- retrospective population-based cross-sectional study using administrative data.
- looks at the association between surgeon and hospital annual experience with outcomes in geriatric patients with EGS conditions.
- Note Table 2 provides outcomes broken down by type of surgery
- Key finding: patients operated on by a low-volume surgeon had about twice the odds of mortality, and 1.7X the odds of failure to rescue

Paper #2: Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. Alive and at home: Five-year outcomes in older adults following emergency general surgery. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295.

- large-scale population-based retrospective cohort study looking at long-term outcomes of older adults with admissions for emergency general surgery diagnoses
- primary outcome of interest is “aging in place” or being able to reside in one’s home for as long as possible.
- Key finding: being admitted for an EGS diagnosis reduces your survival and time in your home by about 7 months.
- Very little reduction in low-risk diagnoses (acute appendicitis/cholecystitis)
- 57% of patients were alive and in their home 5 years later

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Transcript

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0:00.0	Behind the Night, the surgery podcast relevant and engaging content designed to help you dominate the day.
0:13.0	Hello and welcome to episode three in our series on emergency general surgery.
0:26.0	I'm Green Skullhorn Gross and I'm here with Dr. Ashley Nadler and Dr. Jordan Nadler.
0:31.0	Hi.
0:32.0	Hello.
0:33.0	We are excited to talk to you today about emergency general surgery as it pertains to patients over the age of 65.
0:40.0	This subpopulation accounts for 40% of emergency general surgery admissions today, a proportion that we expect to increase with our aging population.
0:49.0	Now we all know patients over 65 are a high risk group.
0:53.0	Many have decreased reserve, poor nutritional status, and chronic medical conditions which affect their ability to handle the stress of their presenting condition, not to mention their operation.
1:04.0	Also, as we've discussed before, in emergency general surgery we often don't have the ability to pre-habilitate our patients since we need to intervene right away.
1:14.0	Altogether, this makes taking care of emergency general surgery patients over 65 or risky business and requires us to use a careful and thoughtful approach.
1:23.0	There is a lot of literature focusing on this population and we want to discuss two important articles that relate to how older patients are cared for in emergency general surgery.
1:33.0	There are a few important definitions to discuss before we begin.
1:37.0	The way we address adults over the age of 65 varies.
1:40.0	My father is 70 and I can tell you he would not appreciate being called elder later geriatric, even though many studies and protocols use these terms.
1:49.0	We'll be using adults over 65, seniors or older adults throw the podcast out of respect, unless we see that these are terms other terms are specifically used by the papers that we're discussing.
2:01.0	But we do recognize that age alone is often not a great cut off to use and frailty will less often assessed is often much more important for assessment and prognostication.
2:11.0	Yeah, frailty has been shown to correlate with various post-op outcomes, but it's assessment often relies on gestalt or how a patient appears rather than a standardized assessment.
2:22.0	There are many frailty scores that can be used, which also complicates standardizing the documentation and assessment of frailty.
2:29.0	Some frailty scores involve many components and questions beyond the typical clinical assessment, which makes them difficult to implement routinely in the acute care surgery and emergency general surgery population.
2:40.0	There's one study that we'd like to turn your attention to, and that's by Engelhart and colleagues. It's in the journal of trauma and acute care surgery published in 2018.
2:49.0	They use a very practical frailty score called the emergency general surgery specific frailty index, and it seems quite easy to use.
	...

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