Evaluating predictors of mortality in octogenarians undergoing urgent or emergent trauma laparotomy.

Publisher: Springer Heidelberg Country of Publication: Germany NLM ID: 101313350 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1863-9941 (Electronic) Linking ISSN: 18639933 NLM ISO Abbreviation: Eur J Trauma Emerg Surg Subsets: MEDLINE

Publication: 2011- : Heidelberg : Springer Heidelberg
Original Publication: Munich : Urban & Vogel, 2007-

Laparotomy*/mortality; Humans ; Male ; Female ; Aged, 80 and over ; Risk Factors ; Retrospective Studies ; Wounds and Injuries/mortality ; Wounds and Injuries/surgery ; Injury Severity Score ; Hospital Mortality

Purpose: This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL).
Methods: Trauma patients ages 80-89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality.
Results: From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25-30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05).
Conclusion: This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)

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Keywords: Emergent laparotomy; Octogenarian operative management; Octogenarian trauma patients; Urgent laparotomy

Date Created: 20241016 Date Completed: 20241223 Latest Revision: 20241223

20241223

10.1007/s00068-024-02635-3

39414632