Emergency Surgery in Aged : Preoperative Condition and Prognosis

Over the past 10 years, the relationships between prognosis and time lapse from attack to surgery, preoperative blood pressure and pulse rate, amount of transfusion and duration of surgery have been studied in patients aged 65 and over subjected to emergency abdominal operations. For these patients, the mortality rate within 30 days after surgery was 38.7% (12/31). During the same 10 year period, for patients about the same age receiving elective abdominal operations the mortality rate was 13.3% (44/332). All measurements except duration of surgery had a positive correlation to the prognosis. A statistically significant difference was found between the preoperative blood pressures in the survivor and non-survivor groups. In patients with perforative peritonitis, a radical operation (gastrointestinal resection) produced better results than a paliative operation (closure of the perforation). However, in patients with intestinal obstruction this finding was reversed : the formation of a fecal fistula was tolerated better than an intestinal resection. It is concluded that as much preoperative preparation as possible should be done even in emergency cases.