Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: A case control study

Shih-Chi Wu, Chih-Yuan Fu, Chi-Hsun Hsieh, Yu-Chun Wang, Hung-Chieh Lo, Han-Tsung Cheng, Chia-Wei Tzeng

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: As our world ages and the elderly population grows. Surgery on the aged critically ill tend to result in additional morbidity and mortality. We sought to determine early predicting factors that were associated with postoperative leakage and tissue healing deficiency after emergent abdominal surgery in geriatric critically ill patients. Material and method: Retrospectively, geriatric critically ill patients received anticipated, single-stage emergent abdominal surgery via emergency room were enrolled. Patients who received only one definitive surgery during their hospital course were labeled as group A, patients received anticipated one-stage surgery and eventually with postoperative leakage and tissue healing deficiency were labeled as group B. The demographics and parameters were obtained for comparison. Result: There were 45 patients in group A, and 34 patients in group B. The mean age is 77.4 ± 6.1 years in Group A and 76.9 ± 8.5 years in Group B, the mean APACHE score was 20.3 ± 7.5 vs. 21.6 ± 7.7. There were no significances in age, gender, comorbidities, and physiological scores. There were significances in the persistent post-operative use of vasopressors and hypoalbuminemia. The 30-day mortality rate was 0% in group A and 38.2% in group B. Conclusion: Persistent post operative vasopressor use and hypoalbuminemia are associated with higher rate of morbidity and mortality after emergent abdominal surgery in geriatric critically ill patients. Early recognition is essential for proper management. Further studies are required for a better understanding in identifying risk factors. © 2014 Surgical Associates Ltd.
Original languageEnglish
Pages (from-to)315-319
Number of pages5
JournalInternational Journal of Surgery
Volume12
Issue number4
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Critical Illness
Geriatrics
Case-Control Studies
Hypoalbuminemia
Mortality
Morbidity
APACHE
Hospital Emergency Service
Comorbidity
Demography
Population

Keywords

  • Geriatric critical ill
  • Hypoalbuminemia
  • Vasopressor
  • adrenalin
  • dopamine
  • noradrenalin
  • abdominal surgery
  • aged
  • anastomosis leakage
  • APACHE
  • article
  • controlled study
  • critically ill patient
  • emergency ward
  • evisceration
  • female
  • geriatric care
  • geriatric patient
  • healing
  • human
  • intensive care
  • intestine perforation
  • ischemia
  • laparoscopic surgery
  • major clinical study
  • male
  • morbidity
  • mortality
  • operative site bleeding
  • postoperative complication
  • postoperative hemorrhage
  • priority journal
  • retrospective study
  • wound dehiscence
  • abdomen
  • age
  • case control study
  • critical illness
  • geriatrics
  • laparotomy
  • Postoperative Complications
  • predictive value
  • procedures
  • reoperation
  • surgery
  • very elderly
  • wound healing
  • Abdomen
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Critical Illness
  • Female
  • Geriatrics
  • Humans
  • Laparotomy
  • Male
  • Predictive Value of Tests
  • Reoperation
  • Wound Healing

Cite this

Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: A case control study. / Wu, Shih-Chi; Fu, Chih-Yuan; Hsieh, Chi-Hsun; Wang, Yu-Chun; Lo, Hung-Chieh; Cheng, Han-Tsung; Tzeng, Chia-Wei.

In: International Journal of Surgery, Vol. 12, No. 4, 2014, p. 315-319.

Research output: Contribution to journalArticle

Wu, Shih-Chi ; Fu, Chih-Yuan ; Hsieh, Chi-Hsun ; Wang, Yu-Chun ; Lo, Hung-Chieh ; Cheng, Han-Tsung ; Tzeng, Chia-Wei. / Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: A case control study. In: International Journal of Surgery. 2014 ; Vol. 12, No. 4. pp. 315-319.
@article{d7481d263cf949db9dd4c248a6196359,
title = "Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: A case control study",
abstract = "Background: As our world ages and the elderly population grows. Surgery on the aged critically ill tend to result in additional morbidity and mortality. We sought to determine early predicting factors that were associated with postoperative leakage and tissue healing deficiency after emergent abdominal surgery in geriatric critically ill patients. Material and method: Retrospectively, geriatric critically ill patients received anticipated, single-stage emergent abdominal surgery via emergency room were enrolled. Patients who received only one definitive surgery during their hospital course were labeled as group A, patients received anticipated one-stage surgery and eventually with postoperative leakage and tissue healing deficiency were labeled as group B. The demographics and parameters were obtained for comparison. Result: There were 45 patients in group A, and 34 patients in group B. The mean age is 77.4 ± 6.1 years in Group A and 76.9 ± 8.5 years in Group B, the mean APACHE score was 20.3 ± 7.5 vs. 21.6 ± 7.7. There were no significances in age, gender, comorbidities, and physiological scores. There were significances in the persistent post-operative use of vasopressors and hypoalbuminemia. The 30-day mortality rate was 0{\%} in group A and 38.2{\%} in group B. Conclusion: Persistent post operative vasopressor use and hypoalbuminemia are associated with higher rate of morbidity and mortality after emergent abdominal surgery in geriatric critically ill patients. Early recognition is essential for proper management. Further studies are required for a better understanding in identifying risk factors. {\circledC} 2014 Surgical Associates Ltd.",
keywords = "Geriatric critical ill, Hypoalbuminemia, Vasopressor, adrenalin, dopamine, noradrenalin, abdominal surgery, aged, anastomosis leakage, APACHE, article, controlled study, critically ill patient, emergency ward, evisceration, female, geriatric care, geriatric patient, healing, human, intensive care, intestine perforation, ischemia, laparoscopic surgery, major clinical study, male, morbidity, mortality, operative site bleeding, postoperative complication, postoperative hemorrhage, priority journal, retrospective study, wound dehiscence, abdomen, age, case control study, critical illness, geriatrics, laparotomy, Postoperative Complications, predictive value, procedures, reoperation, surgery, very elderly, wound healing, Abdomen, Age Factors, Aged, Aged, 80 and over, Case-Control Studies, Critical Illness, Female, Geriatrics, Humans, Laparotomy, Male, Predictive Value of Tests, Reoperation, Wound Healing",
author = "Shih-Chi Wu and Chih-Yuan Fu and Chi-Hsun Hsieh and Yu-Chun Wang and Hung-Chieh Lo and Han-Tsung Cheng and Chia-Wei Tzeng",
note = "被引用次數:1 Export Date: 24 March 2016 通訊地址: Wu, S.-C.; Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan; 電子郵件: rw114@mail.cmuh.org.tw 化學物質/CAS: adrenalin, 51-43-4, 55-31-2, 6912-68-1; dopamine, 51-61-6, 62-31-7; noradrenalin, 1407-84-7, 51-41-2 參考文獻: Sieber, C.C., The elderly patient - who is that? (2007) Internist (Berl.), 48, pp. 1190-1194; Rockwood, K., Song, X., MacKnight, C., A global clinical measure of fitness and frailty in elderly people (2005) CMAJ, 30 (173), pp. 489-495; Ferrucci, L., Guralnik, J.M., Cavazzini, C., The frailty syndrome: a critical issue in geriatric oncology (2003) Crit. Rev. Oncol. Hematol., 46, pp. 127-137; Counsell, S.R., Callahan, C.M., Clark, D.O., Geriatric care management for low-income seniors: a randomized controlled trial (2007) JAMA, 298, pp. 2623-2633; Abbas, S., Booth, M., Major abdominal surgery in octogenarians (2003) N. Z. Med. J., 116 (1172), pp. U402; Huang, T.S., Hu, F.C., Fan, C.W., A simple novel model to predict hospital mortality, surgical site infection, and pneumonia in elderly patients undergoing operation (2010) Dig. Surg., 27 (3), pp. 224-231; Dellinger, R.P., Levy, M.M., Carlet, J.M., Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008 (2008) Crit. Care Med., 36 (1), pp. 296-327; Finfer, S., Bellomo, R., McEvoy, S., Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study (2006) BMJ, 333 (7577), p. 1044. , SAFE Study Investigators; Mohil, R.S., Bhatnagar, D., Bahadur, L., POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy (2004) Br. J. Surg., 91 (4), pp. 500-503; Tran Ba Loc, P., du Montcel, S.T., Duron, J.J., Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients (2010) Br. J. Surg., 97 (3), pp. 396-403; Kroon, H.M., Breslau, P.J., Lardenoye, J.W., Can the incidence of unplanned re-operations be used as an indicator of quality of care in surgery? (2007) Am. J. Med. Qual., 22 (3), pp. 198-202; Louis, D.J., Hsu, A., Brand, M.I., Morbidity and mortality in octogenarians and older undergoing major intestinal surgery (2009) Dis. Colon Rectum, 52 (1), pp. 59-63; Story, D.A., Postoperative complications in elderly patients and their significance for long-term prognosis (2008) Curr. Opin. Anaesthesiol., 21 (3), pp. 375-379; Makary, M.A., Segev, D.L., Pronovost, P.J., Frailty as a predictor of surgical outcomes in older patients (2010) J. Am. Coll. Surg., 210 (6), pp. 901-908; Hyman, N.H., Managing anastomotic leaks from intestinal anastomoses (2009) Surgeon, 7 (1), pp. 31-35; Burger, J.W., Lange, J.F., Halm, J.A., Incisional hernia: early complication of abdominal surgery (2005) World J. Surg., 29 (12), pp. 1608-1613; Ohmann, C., Yang, Q., Hau, T., Wacha, H., Prognostic modelling in peritonitis. Peritonitis Study Group of the Surgical Infection Society Europe (1997) Eur. J. Surg., 163, pp. 53-60; Pacelli, F., Doglietto, G.B., Alfieri, S., Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients (1996) Arch. Surg., 131, pp. 641-645; Robinson, T.N., Eiseman, B., Wallace, J.I., Redefining geriatric preoperative assessment using frailty, disability and co-morbidity (2009) Ann. Surg., 250 (3), pp. 449-455; Chang, T.T., Schecter, W.P., Injury in the elderly and end-of-life decisions (2007) Surg. Clin. North Am., 87 (1), pp. 229-245; Marik, P.E., Management of the critically ill geriatric patient (2006) Crit. Care Med., 34 (9 SUPPL.), pp. S176-S182; Mikkelsen, M.E., Miltiades, A.N., Gaieski, D.F., Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock (2009) Crit. Care Med., 37 (5), pp. 1670-1677; Trzeciak, S., Dellinger, R.P., Chansky, M.E., Serum lactate as a predictor of mortality in patients with infection (2007) Intensive Care Med., 33 (6), pp. 970-977; Arnold, R.C., Shapiro, N.I., Jones, A.E., Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis (2009) Shock, 32 (1), pp. 35-39; Lang, J.D., Figueroa, M., Chumley, P., Albumin and hydroxyethyl starch modulate oxidative inflammatory injury to vascular endothelium (2004) Anesthesiology, 100, pp. 51-58; Quinlan, G.J., Margarson, M.P., Mumby, S., Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion (1998) Clin. Sci. (Lond.), 95, pp. 459-465; Daley, J., Khuri, S.F., Henderson, W., Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study (1997) J. Am. Coll. Surg., 185 (4), pp. 328-340; Golub, R., Golub, R.W., Cantu, R., A multivariate analysis of factors contributing to leakage of intestinal anastomoses (1997) J. Am. Coll. Surg., 184 (4), pp. 364-372; Goldwasser, P., Feldman, J., Association of serum albumin and mortality risk (1997) J. Clin. Epidemiol., 50 (6), pp. 693-703; Hennessey, D.B., Burke, J.P., Ni-Dhonochu, T., Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study (2010) Ann. Surg., 252 (2), pp. 325-329; Sung, J., Bochicchio, G.V., Joshi, M., Admission serum albumin is predictive of outcome in critically ill trauma patients (2004) Am. Surg., 70 (12), pp. 1099-1102; Herrmann, F.R., Safran, C., Levkoff, S.E., Serum albumin level on admission as a predictor of death, length of stay, and readmission (1992) Arch. Intern. Med., 152 (1), pp. 125-130; Nair, A., Pai, D.R., Jagdish, S., Predicting anastomotic disruption after emergent small bowel surgery. Predicting anastomotic disruption after emergent small bowel surgery (2006) Dig. Surg., 23 (1-2), pp. 38-43; Zakrison, T., Nascimento, B.A., Tremblay, L.N., Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage (2007) World J. Surg., 31 (8), pp. 1627-1634; Eltarawy, I.G., Etman, Y.M., Zenati, M., Acute mesenteric ischemia: the importance of early surgical consultation (2009) Am. Surg., 75 (3), pp. 212-219; Russell, J.A., Vasopressin in vasodilatory and septic shock (2007) Curr. Opin. Crit. Care, 13 (4), pp. 383-391; Obritsch, M.D., Bestul, D.J., Jung, R., The role of vasopressin in vasodilatory septic shock (2004) Pharmacotherapy, 24 (8), pp. 1050-1063; Lin, M.Y., Rezai, K., Schwartz, D.N., Septic pulmonary emboli and bacteremia associated with deep tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus (2008) J. Clin. Microbiol., 46 (4), pp. 1553-1555; Cook, R.J., Ashton, R.W., Aughenbaugh, G.L., Septic pulmonary embolism: presenting features and clinical course of 14 patients (2005) Chest, 128 (1), pp. 162-166; Abenza-Abildua, M.J., Fuentes-Gimeno, B., Morales-Bastos, C., Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient (2009) J. Neurol. Sci., 284 (1-2), pp. 209-210; Ruler, O.V., Mahler, C.W., Boer, K.R., Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial (2007) JAMA, 298, pp. 865-873; Dubois, M.J., Orellana-Jimenez, C., Melot, C., Albumin administration improves organ function in critically ill hypoalbuminemic patients: a prospective, randomized, controlled, pilot study (2006) Crit. Care Med., 34 (10), pp. 2536-2540; Vincent, J.L., Relevance of albumin in modern critical care medicine (2009) Best Pract. Res. Clin. Anaesthesiol., 23 (2), pp. 183-191; Finfer, S., Myburgh, J., Bellomo, R., Albumin supplementation and organ function (2007) Crit. Care. Med., 35 (3), pp. 987-988",
year = "2014",
doi = "10.1016/j.ijsu.2014.01.016",
language = "English",
volume = "12",
pages = "315--319",
journal = "International Journal of Surgery",
issn = "1743-9191",
publisher = "Elsevier Science Publishers B.V.",
number = "4",

}

TY - JOUR

T1 - Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: A case control study

AU - Wu, Shih-Chi

AU - Fu, Chih-Yuan

AU - Hsieh, Chi-Hsun

AU - Wang, Yu-Chun

AU - Lo, Hung-Chieh

AU - Cheng, Han-Tsung

AU - Tzeng, Chia-Wei

N1 - 被引用次數:1 Export Date: 24 March 2016 通訊地址: Wu, S.-C.; Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung 404, Taiwan; 電子郵件: rw114@mail.cmuh.org.tw 化學物質/CAS: adrenalin, 51-43-4, 55-31-2, 6912-68-1; dopamine, 51-61-6, 62-31-7; noradrenalin, 1407-84-7, 51-41-2 參考文獻: Sieber, C.C., The elderly patient - who is that? (2007) Internist (Berl.), 48, pp. 1190-1194; Rockwood, K., Song, X., MacKnight, C., A global clinical measure of fitness and frailty in elderly people (2005) CMAJ, 30 (173), pp. 489-495; Ferrucci, L., Guralnik, J.M., Cavazzini, C., The frailty syndrome: a critical issue in geriatric oncology (2003) Crit. Rev. Oncol. Hematol., 46, pp. 127-137; Counsell, S.R., Callahan, C.M., Clark, D.O., Geriatric care management for low-income seniors: a randomized controlled trial (2007) JAMA, 298, pp. 2623-2633; Abbas, S., Booth, M., Major abdominal surgery in octogenarians (2003) N. Z. Med. J., 116 (1172), pp. U402; Huang, T.S., Hu, F.C., Fan, C.W., A simple novel model to predict hospital mortality, surgical site infection, and pneumonia in elderly patients undergoing operation (2010) Dig. Surg., 27 (3), pp. 224-231; Dellinger, R.P., Levy, M.M., Carlet, J.M., Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008 (2008) Crit. Care Med., 36 (1), pp. 296-327; Finfer, S., Bellomo, R., McEvoy, S., Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study (2006) BMJ, 333 (7577), p. 1044. , SAFE Study Investigators; Mohil, R.S., Bhatnagar, D., Bahadur, L., POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy (2004) Br. J. Surg., 91 (4), pp. 500-503; Tran Ba Loc, P., du Montcel, S.T., Duron, J.J., Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients (2010) Br. J. Surg., 97 (3), pp. 396-403; Kroon, H.M., Breslau, P.J., Lardenoye, J.W., Can the incidence of unplanned re-operations be used as an indicator of quality of care in surgery? (2007) Am. J. Med. Qual., 22 (3), pp. 198-202; Louis, D.J., Hsu, A., Brand, M.I., Morbidity and mortality in octogenarians and older undergoing major intestinal surgery (2009) Dis. Colon Rectum, 52 (1), pp. 59-63; Story, D.A., Postoperative complications in elderly patients and their significance for long-term prognosis (2008) Curr. Opin. Anaesthesiol., 21 (3), pp. 375-379; Makary, M.A., Segev, D.L., Pronovost, P.J., Frailty as a predictor of surgical outcomes in older patients (2010) J. Am. Coll. Surg., 210 (6), pp. 901-908; Hyman, N.H., Managing anastomotic leaks from intestinal anastomoses (2009) Surgeon, 7 (1), pp. 31-35; Burger, J.W., Lange, J.F., Halm, J.A., Incisional hernia: early complication of abdominal surgery (2005) World J. Surg., 29 (12), pp. 1608-1613; Ohmann, C., Yang, Q., Hau, T., Wacha, H., Prognostic modelling in peritonitis. Peritonitis Study Group of the Surgical Infection Society Europe (1997) Eur. J. Surg., 163, pp. 53-60; Pacelli, F., Doglietto, G.B., Alfieri, S., Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients (1996) Arch. Surg., 131, pp. 641-645; Robinson, T.N., Eiseman, B., Wallace, J.I., Redefining geriatric preoperative assessment using frailty, disability and co-morbidity (2009) Ann. Surg., 250 (3), pp. 449-455; Chang, T.T., Schecter, W.P., Injury in the elderly and end-of-life decisions (2007) Surg. Clin. North Am., 87 (1), pp. 229-245; Marik, P.E., Management of the critically ill geriatric patient (2006) Crit. Care Med., 34 (9 SUPPL.), pp. S176-S182; Mikkelsen, M.E., Miltiades, A.N., Gaieski, D.F., Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock (2009) Crit. Care Med., 37 (5), pp. 1670-1677; Trzeciak, S., Dellinger, R.P., Chansky, M.E., Serum lactate as a predictor of mortality in patients with infection (2007) Intensive Care Med., 33 (6), pp. 970-977; Arnold, R.C., Shapiro, N.I., Jones, A.E., Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis (2009) Shock, 32 (1), pp. 35-39; Lang, J.D., Figueroa, M., Chumley, P., Albumin and hydroxyethyl starch modulate oxidative inflammatory injury to vascular endothelium (2004) Anesthesiology, 100, pp. 51-58; Quinlan, G.J., Margarson, M.P., Mumby, S., Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion (1998) Clin. Sci. (Lond.), 95, pp. 459-465; Daley, J., Khuri, S.F., Henderson, W., Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study (1997) J. Am. Coll. Surg., 185 (4), pp. 328-340; Golub, R., Golub, R.W., Cantu, R., A multivariate analysis of factors contributing to leakage of intestinal anastomoses (1997) J. Am. Coll. Surg., 184 (4), pp. 364-372; Goldwasser, P., Feldman, J., Association of serum albumin and mortality risk (1997) J. Clin. Epidemiol., 50 (6), pp. 693-703; Hennessey, D.B., Burke, J.P., Ni-Dhonochu, T., Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study (2010) Ann. Surg., 252 (2), pp. 325-329; Sung, J., Bochicchio, G.V., Joshi, M., Admission serum albumin is predictive of outcome in critically ill trauma patients (2004) Am. Surg., 70 (12), pp. 1099-1102; Herrmann, F.R., Safran, C., Levkoff, S.E., Serum albumin level on admission as a predictor of death, length of stay, and readmission (1992) Arch. Intern. Med., 152 (1), pp. 125-130; Nair, A., Pai, D.R., Jagdish, S., Predicting anastomotic disruption after emergent small bowel surgery. Predicting anastomotic disruption after emergent small bowel surgery (2006) Dig. Surg., 23 (1-2), pp. 38-43; Zakrison, T., Nascimento, B.A., Tremblay, L.N., Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage (2007) World J. Surg., 31 (8), pp. 1627-1634; Eltarawy, I.G., Etman, Y.M., Zenati, M., Acute mesenteric ischemia: the importance of early surgical consultation (2009) Am. Surg., 75 (3), pp. 212-219; Russell, J.A., Vasopressin in vasodilatory and septic shock (2007) Curr. Opin. Crit. Care, 13 (4), pp. 383-391; Obritsch, M.D., Bestul, D.J., Jung, R., The role of vasopressin in vasodilatory septic shock (2004) Pharmacotherapy, 24 (8), pp. 1050-1063; Lin, M.Y., Rezai, K., Schwartz, D.N., Septic pulmonary emboli and bacteremia associated with deep tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus (2008) J. Clin. Microbiol., 46 (4), pp. 1553-1555; Cook, R.J., Ashton, R.W., Aughenbaugh, G.L., Septic pulmonary embolism: presenting features and clinical course of 14 patients (2005) Chest, 128 (1), pp. 162-166; Abenza-Abildua, M.J., Fuentes-Gimeno, B., Morales-Bastos, C., Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient (2009) J. Neurol. Sci., 284 (1-2), pp. 209-210; Ruler, O.V., Mahler, C.W., Boer, K.R., Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial (2007) JAMA, 298, pp. 865-873; Dubois, M.J., Orellana-Jimenez, C., Melot, C., Albumin administration improves organ function in critically ill hypoalbuminemic patients: a prospective, randomized, controlled, pilot study (2006) Crit. Care Med., 34 (10), pp. 2536-2540; Vincent, J.L., Relevance of albumin in modern critical care medicine (2009) Best Pract. Res. Clin. Anaesthesiol., 23 (2), pp. 183-191; Finfer, S., Myburgh, J., Bellomo, R., Albumin supplementation and organ function (2007) Crit. Care. Med., 35 (3), pp. 987-988

PY - 2014

Y1 - 2014

N2 - Background: As our world ages and the elderly population grows. Surgery on the aged critically ill tend to result in additional morbidity and mortality. We sought to determine early predicting factors that were associated with postoperative leakage and tissue healing deficiency after emergent abdominal surgery in geriatric critically ill patients. Material and method: Retrospectively, geriatric critically ill patients received anticipated, single-stage emergent abdominal surgery via emergency room were enrolled. Patients who received only one definitive surgery during their hospital course were labeled as group A, patients received anticipated one-stage surgery and eventually with postoperative leakage and tissue healing deficiency were labeled as group B. The demographics and parameters were obtained for comparison. Result: There were 45 patients in group A, and 34 patients in group B. The mean age is 77.4 ± 6.1 years in Group A and 76.9 ± 8.5 years in Group B, the mean APACHE score was 20.3 ± 7.5 vs. 21.6 ± 7.7. There were no significances in age, gender, comorbidities, and physiological scores. There were significances in the persistent post-operative use of vasopressors and hypoalbuminemia. The 30-day mortality rate was 0% in group A and 38.2% in group B. Conclusion: Persistent post operative vasopressor use and hypoalbuminemia are associated with higher rate of morbidity and mortality after emergent abdominal surgery in geriatric critically ill patients. Early recognition is essential for proper management. Further studies are required for a better understanding in identifying risk factors. © 2014 Surgical Associates Ltd.

AB - Background: As our world ages and the elderly population grows. Surgery on the aged critically ill tend to result in additional morbidity and mortality. We sought to determine early predicting factors that were associated with postoperative leakage and tissue healing deficiency after emergent abdominal surgery in geriatric critically ill patients. Material and method: Retrospectively, geriatric critically ill patients received anticipated, single-stage emergent abdominal surgery via emergency room were enrolled. Patients who received only one definitive surgery during their hospital course were labeled as group A, patients received anticipated one-stage surgery and eventually with postoperative leakage and tissue healing deficiency were labeled as group B. The demographics and parameters were obtained for comparison. Result: There were 45 patients in group A, and 34 patients in group B. The mean age is 77.4 ± 6.1 years in Group A and 76.9 ± 8.5 years in Group B, the mean APACHE score was 20.3 ± 7.5 vs. 21.6 ± 7.7. There were no significances in age, gender, comorbidities, and physiological scores. There were significances in the persistent post-operative use of vasopressors and hypoalbuminemia. The 30-day mortality rate was 0% in group A and 38.2% in group B. Conclusion: Persistent post operative vasopressor use and hypoalbuminemia are associated with higher rate of morbidity and mortality after emergent abdominal surgery in geriatric critically ill patients. Early recognition is essential for proper management. Further studies are required for a better understanding in identifying risk factors. © 2014 Surgical Associates Ltd.

KW - Geriatric critical ill

KW - Hypoalbuminemia

KW - Vasopressor

KW - adrenalin

KW - dopamine

KW - noradrenalin

KW - abdominal surgery

KW - aged

KW - anastomosis leakage

KW - APACHE

KW - article

KW - controlled study

KW - critically ill patient

KW - emergency ward

KW - evisceration

KW - female

KW - geriatric care

KW - geriatric patient

KW - healing

KW - human

KW - intensive care

KW - intestine perforation

KW - ischemia

KW - laparoscopic surgery

KW - major clinical study

KW - male

KW - morbidity

KW - mortality

KW - operative site bleeding

KW - postoperative complication

KW - postoperative hemorrhage

KW - priority journal

KW - retrospective study

KW - wound dehiscence

KW - abdomen

KW - age

KW - case control study

KW - critical illness

KW - geriatrics

KW - laparotomy

KW - Postoperative Complications

KW - predictive value

KW - procedures

KW - reoperation

KW - surgery

KW - very elderly

KW - wound healing

KW - Abdomen

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Case-Control Studies

KW - Critical Illness

KW - Female

KW - Geriatrics

KW - Humans

KW - Laparotomy

KW - Male

KW - Predictive Value of Tests

KW - Reoperation

KW - Wound Healing

U2 - 10.1016/j.ijsu.2014.01.016

DO - 10.1016/j.ijsu.2014.01.016

M3 - Article

VL - 12

SP - 315

EP - 319

JO - International Journal of Surgery

JF - International Journal of Surgery

SN - 1743-9191

IS - 4

ER -