Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients
Abstract
:1. Aim
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Co-Morbidities | N | % on 120 |
---|---|---|
Heart attack (<6 months) | 1 | 0.8 |
Heart failure (<30 days) | 5 | 4.2 |
Chronic heart failure | 48 | 40 |
Previous coronary by-pass | 26 | 21.7 |
Hypertension | 93 | 77.5 |
Cerebrovascular diseases | 30 | 25 |
Peripheral chronic obstructive arterial disease | 18 | 15 |
Use of oral anticoagulant | 28 | 23.3 |
Pulmonary diseases | 26 | 21.7 |
Metastatic cancer | 6 | 5 |
Non-metastatic cancer | 21 | 17.5 |
Renal diseases | 20 | 16.7 |
Diabetes | 37 | 30.8 |
Use of immunosuppressant drugs | 8 | 6.7 |
Actual smoker | 8 | 6.7 |
Previous smoker | 37 | 30.8 |
Causes of Death | N | % on 34 | ASA Score | % ASA Scores on 34 | p (0.05) |
---|---|---|---|---|---|
Medical/surgical during recovery | 6 | 17.6 | ASA 1: 0 ASA 2: 0 ASA 3: 5 ASA 4: 1 | 0 0 14.7 2.9 | 0.68 |
Medical/surgical < 30 days | 13 | 38.2 | ASA 1: 0 ASA 2: 5 ASA 3: 8 ASA 4: 0 | 0 14.7 23.5 0 | |
Cardiovascular diseases < 2 years ∞ | 8 | 23.5 | ASA 1: 0 ASA 2: 0 ASA 3: 8 ASA 4: 0 | 0 0 23.5 0 | |
Evolution of comorbidities—other | 7 | 20.7 | ASA 1: 0 ASA 2: 0 ASA 3: 6 ASA 4: 1 | 0 5.9 17.6 2.9 |
Causes of Death | N | Type of Surgery (% on 34) | p (0.05) |
---|---|---|---|
Medical/surgical during recovery | 6 | Laparoscopic: 0 (0) Open: 6 (17.6) Converted: 0 (0) | 0.5 |
Medical/surgical < 30 days | 13 | Laparoscopic: 4 (11.8) Open: 8 (23.5) Converted: 1 (2.9) | |
Cardiovascular diseases < 2 years ∞ | 8 | Laparoscopic: 3 (8.9) Open: 5 (14.7) Converted: 0 (0) |
Complications (% on 120) | Death (% on 120) | p (0.05) | Type of Surgery (% on 120) | p (0.05) |
---|---|---|---|---|
yes: 19 (15.8) | 9 (7.5) | 0.04 | Laparoscopic: 7 (5.8) Open: 12 (10) Converted: 0 (0) | 0.03 |
no: 101 (84.2) | 25 (20.8) | Laparoscopic: 63 (52.5) Open: 37 (30.9) Converted: 1 (0.8) |
Clavien Dindo | N (% on 120) | Death (% on 120) | p (0.05) |
---|---|---|---|
1 | 4 (3.3) | 0 (0) | 0.8 |
2 | 0 (0) | 0 (0) | |
3a | 3 (2.5) | 1 (0.8) | |
3b | 4 (3.3) | 1 (0.8) | |
4a | 3 (2.5) | 2 (1.6) | |
4b | 0 (0) | 0 (0) | |
5 | 5 (4.2) | 5 (4.2) |
Abdominal Surgery | N (% on 120) | Type of Surgery (% on 120) | p (0.05) | N of Death (% on 120) | p (0.05) | Type of Surgery–Death (% on 120) | p (0.05) |
---|---|---|---|---|---|---|---|
Cholecystectomy | 43 (35.8) | Laparoscopic: 41 (34.2) Open: 2 (1.6) Converted: 0 (0) | <0.001 | 7 (5.8) | <0.04 | Laparoscopic: 6 (5) Open: 1 (0.8) Converted: 0 (0) | <0.03 |
Appendectomy | 10 (8.4) | Laparoscopic: 9 (7.5) Open: 1 (0.8) Converted: 0 (0) | 2 (1.7) | Laparoscopic: 2 (1.7) Open: 0 (0) Converted: 0 (0) | |||
Ileal resection | 19 (15.8) | Laparoscopic: 2 (1.6) Open: 17 (14.2) Converted: 0 (0) | 6 (5) | Laparoscopic: 0 (0) Open: 6 (5) Converted: 0 (0) | |||
Colic resection | 32 (26.7) | Laparoscopic: 15 (12.5) Open: 16 (13.3) | 16 (13.3) | Laparoscopic: 6 (5) Open: 9 (7.5) Converted: 1 (0.8) | |||
Converted: 1 (0.8) | |||||||
Inguinal hernia reparation | 13 (10.8) | Laparoscopic: 1 (0.8) Open: 12 (10) Converted: 0 (0) | 3 (2.5) | Laparoscopic: 0 (0) Open: 3 (2.5) Converted: 0 (0) | |||
Incarcerated abdominal wall hernia reparation | 3 (2.5) | Laparoscopic: 2 (1.6) Open: 1 (0.8) Converted: 0 (0) | 0 (0) | Laparoscopic: 0 (0) Open: 0 (0) Converted: 0 (0) |
Type of Surgery | Mortality N (% on 120) | p (0.05) |
---|---|---|
Laparoscopy | 14 (11.7) | 0.02 |
Open | 19 (15.8) | |
Converted | 1 (0.8) |
Frailty Score Criteria | Weight Loss in the Previous 3 Months (>10%) | Active Mobilization | Endurance | Weakness | Slowness |
---|---|---|---|---|---|
N (120) at recovery (% on 120) | 4 (3.3) | 71 (59.2) | 17 (14.2) | 22 (18.3) | 112 (93.3) |
N (86) at 2 years (% on 86) | 8 (9.3) | 60 (69.8) | 10 (11.6) | 22 (25.6) | 85 (98.9) |
p (0.05) | 0.44 | ||||
Type of surgery at recovery | |||||
Laparoscopy | 1 (0.8) | 47 (39.2) | 5 (4.2) | 6 (5) | 67 (55.8) |
Laparotomy | 1 (0.8) | 23 (19.2) | 12 (10) | 16 (13.3) | 44 (36.7) |
Converted | 0 (0) | 1 (0.8) | 0 (0) | 0 (0) | 1 (0.8) |
Type of surgery N (86) at 2 years (% on 86) | |||||
Laparoscopy | 2 (2.3) | 40 (46.5) | 4 (4.7) | 11 (12.8) | 55 (64) |
Laparotomy | 6 (7) | 20 (23.2) | 6 (7) | 11 (12.8) | 30 (34.9) |
Converted | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
p (0.05) | 0.0005 |
Statistical Regression | |
---|---|
Multiple R | 0.950090474 |
R2 | 0.902671908 |
Adjusted R2 | 0.891756608 |
Standard error | 0.148876201 |
Observations | 120 |
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Zese, M.; Finotti, E.; Cestaro, G.; Cavallo, F.; Prando, D.; Gobbi, T.; Zese, R.; Di Saverio, S.; Agresta, F. Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients. Surgeries 2021, 2, 119-127. https://doi.org/10.3390/surgeries2010011
Zese M, Finotti E, Cestaro G, Cavallo F, Prando D, Gobbi T, Zese R, Di Saverio S, Agresta F. Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients. Surgeries. 2021; 2(1):119-127. https://doi.org/10.3390/surgeries2010011
Chicago/Turabian StyleZese, Monica, Elena Finotti, Giovanni Cestaro, Fabio Cavallo, Daniela Prando, Tobia Gobbi, Riccardo Zese, Salomone Di Saverio, and Ferdinando Agresta. 2021. "Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients" Surgeries 2, no. 1: 119-127. https://doi.org/10.3390/surgeries2010011