Is age over 80 an independent risk factor for mortality in emergency abdominal surgery? An observational prospective study

Position du problème et objectif(s) de l’étude

Digestive emergencies requiring surgical intervention are a common cause of hospitalization, increasingly affecting elderly patients (approximately 25%). In recent years, several risk factors for mortality and post-operative complications following emergency abdominal surgery have been identified, including the ASA score and pre-operative anemia. However, the role of age remains debated, with inconsistent and limited evidence. This presents a significant and ongoing challenge when evaluating the benefit-risk balance of urgent abdominal surgery, especially for patients aged 80 years or older. This prospective observational study aims to determine whether age ≥ 80 years is an independent risk factor for 90-days mortality (POD90) following emergency abdominal surgery.

Matériel et méthodes

In this single center prospective observational study (IRB CERAR reference 00010254 – 2023 – 042), all consecutive patients aged ≥ 60 years who underwent emergency abdominal surgery between August, 2023 and October, 2024 at a French university hospital were included. Patients’ characteristics, initial biology, surgery type and modalities, anesthesia, postoperative outcomes, and mortality (POD90) were prospectively recorded and compared between patients aged 60–79 years and those aged ≥80 years. The primary endpoint of the study was the all-cause mortality at POD90. Risk factors for mortality were analyzed using a multivariate logistic regression.

Résultats & Discussion

During the study period 407 patients over 60 years old underwent emergency abdominal surgery and were included (301 aged 60–79 years and 106 aged ≥80 years). Patients aged ≥80 years had more comorbidities: a higher proportion of pre-operative ASA score ≥3 (49% vs 34%, p = 0.012), higher median Charlson Comorbidity Index (CCI) (6.5 [5.0–8.0] vs 4.0 [3.0–7.0], p < 0.001), and more frequent histories of stroke (14% vs 6%, p = 0.008), vascular disease (63% vs 40%, p < 0.001), and dementia (11% vs 2%, p < 0.001). They more frequently required urgent surgical intervention (75% vs 52%, p < 0.001). Mortality at POD90 did not significantly differ between groups in univariate analysis (14% vs 9.6%, p = 0.2). Multivariate analysis revealed that age ≥80 years was not significantly associated with 90-day all-cause mortality (OR = 1.65; 95% CI: 0.70–3.83; p = 0.20). Independent predictors for 90-day mortality included ASA score (OR = 3.28; 95% CI: 1.98–5.75; p < 0.001), moderate and severe renal disease (OR = 3.67; 95% CI: 1.47–9.15; p = 0.005), body mass index (BMI) (OR = 0.92; 95% CI: 0.84–0.99; p = 0.032), and preoperative hemoglobin (OR = 0.84; 95% CI: 0.71–0.99; p = 0.042).

Conclusion

In this prospective study, age ≥ 80 years was not independently associated with 90-day mortality after emergency abdominal surgery. Other parameters such as preoperative ASA score, renal function, BMI, and hemoglobin levels were independently associated with mortality at POD90. These findings suggest that decision-making in elderly patients should prioritize physiological status over chronological age.

Auteurs

Clara BOUCHET (1) , Emmanuel PARDO (2), Natacha KAPANDJI (2), Thibault VORON (3), Daniel EL KHOURY (2), Franck VERDONK (2), Amélie CAMBRIEL (2) - (1)Sorbonne Université, Grc 29, Groupe De Recherche Clinique En Anesthésie Réanimation Médecine Périopératoire, Arpe, F-75012 Paris, France. Aphp, Hôpital Saint Antoine And Tenon, Dmu Dream, Department Of Anesthesiology And Critical Care, F-75012, Paris, France, (2)Sorbonne Université, Grc 29, Groupe De Recherche Clinique En Anesthésie Réanimation Médecine Périopératoire, Arpe, F-75012 Paris, France. Aphp, Hôpital Saint Antoine And Tenon, Dmu Dream, Department Of Anesthesiology And Critical Care, F-75012 Paris, France, Paris, France, (3)Sorbonne University And Department Of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux De Paris, Paris, France, Paris, France

Orateur(s)

Clara BOUCHET (Paris)