Abstract
Objective: A significant portion of admissions to emergency departments are made up of elderly patients. We aim to determine the causes of acute abdomen in geriatric patients requiring emergency surgery, evaluate postoperative intensive care needs and mortality rates, and raise awareness about this patient group. Methods: Patient files of individuals aged 65 and older who were consulted in our hospital's emergency department and subsequently admitted to the general surgery service between 2021 and 2023 were retrospectively reviewed. Data including age, gender, underlying diseases, additional illnesses, duration of stay in the intensive care unit, cause of mortality, and length of hospital stay were extracted from the patient's records. The collected data were analyzed statistically for comparisons. Results: Data of 27 patients were accessed.these patients, 40.7% (n=11) were female, and 59.3% (n=16) were male. The average age of the patients was determined to be 74.81 years (ranging from 65 to 88). Thirteen patients, comprising 5 males and 8 females, were monitored in the intensive care unit. 6 patients experienced mortality, and all of them were those admitted to the intensive care unit. When comparing mortality rates based on gender, it was 18.8% in male patients and 27.3% in female patients. All 27 patients had at least one comorbidity. Patients who experienced mortality had at least two comorbidities. Twelve patients did not undergo surgery. Conclisions: In the emergency assessment of geriatric patients, a prompt diagnosis should be made, considering comorbidities after diagnosis, and follow-up and treatments should be adjusted multidisciplinary for patients requiring intensive care or those to be monitored in regular rooms.
Keywords
References
- World Population Prospects 2019: Highlights. Https://population.un.org/wpp/Publications/Files/ WPP2019_10KeyFindings.pdf. (Erişim Tarihi:18.11.2020)
- TÜİK nüfus projeksiyonları 2018-2080. https://www. tuseb.gov.tr/enstitu/tacese/haber_detay.php?id=72. (ErişimTarihi:18.11.2020)
- Çilingir D, Bayraktar N. Günübirlik cerrahi süreci ve hemşirelik bakımı. Hacettepe Üniversitesi Hemşirelik Yüksekokulu Dergisi 2006;13:69-81.
- Blansfield JA, Clark SC, Hofmann MT, et al. Alimentary tract surgery in the nonagenarian: Elective vs. emergent operations. J Gast Surg. 2004;8:539-42.
- Baum SA, Rubenstein LZ. Old people in the emergency room: Age-related differences in emergency department use and care. J Am Geriatr Soc. 1987;35(5):398-404.
- Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinicalcourse of abdominal pain in senior patients: A prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60(8):1071-6.
- Marco CA, Schoenfeld CN, Keyl PM, Menkes ED, Doehring MC. Abdominal pain in geriatric emergency patients: Variables associated with adverse outcomes. Acad Emerg Med 1998;5(12):1163-8.
- Birnbaumer D. Abdominal pain in the elderly patient. http://www.epmonthly.com/cme/current-issue/abdominal-pain-in-theelderly-patient-/1/ (accessed on March 2013).
- Hendrickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Med Clin N Am. 2003;21(4):937-69
- McNamara R. Abdominal pain in elderly. In: Tintinalli JE, Kelen GD, Stapczynski JS, (eds). Emergency Medicine. 6 th ed. New York: Mc Graw Hill; 2004:501-5
- Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin N Am. 2006;24(2):371-88
- Ağalar F, Özdoğan M, Daphan ÇE, Topaloğlu S, Sayek İ. The results of surgical treatment in the elderly acute abdomen patients. Turkish Journal of Geriatrics. 1999;2:1-4.
- Reiss R, Deutsch AA. Emergency Abdominal Procedures in Patients Above 70. J Gerontology. 1985; 40:154
- Fenyö G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am J Surg. 1982;143(6):751-754.
- Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006;74:1537-44.
- Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003;46:111-6.
- Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52.
- Adesunkanmi AR, Agbakwuru EA, Badmus TA. Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria. East Afr Med J. 2000;77:31-3.
- Marco CA, Schoenfeld CN, Keyl PM, Menkes ED, Doehring MC. Abdominal pain in geriatric emergency patients: variables associated with adverse outcomes. Acad Emerg Med. 1998;5:1163-8.
- Rigberg D, Cole M, Hiyama D, McFadden D. Surgery in the nineties. Am Surg. 2000;66:813-6.
- Nursal TZ, Hamaloğlu E. Gastrointestinal surgery in the elderly. Turkish Journal of Geriatrics. 1999;2:22-5.
- Potts FE, Vukov LF. Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond. J Gerontol A Biol Sci Med Sci. 1999;54:55-8.
- Mamode N, Pickford I, Leiberman P. Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg 1999;165:203-8.
Abstract
Amaç: Acil servislere başvuruların önemli bir kısmını yaşlı hastalar oluşturmaktadır. Acil cerrahi gerektiren geriatrik hastalarda akut karın nedenlerini belirlemeyi, postoperatif yoğun bakım ihtiyaçlarını ve mortalite oranlarını değerlendirmeyi ve bu hasta grubu hakkında farkındalık yaratmayı amaçlıyoruz. Yöntem: 2021-2023 yılları arasında hastanemiz acil servisine başvuran ve sonrasında genel cerrahi servisine yatırılan 65 yaş ve üzeri bireylerin hasta dosyaları geriye dönük olarak incelendi. Hasta kayıtlarından yaş, cinsiyet, altta yatan hastalıklar, ek hastalıklar, yoğun bakımda kalış süresi, ölüm nedeni, hastanede kalış süresi gibi veriler elde edildi. Toplanan veriler karşılaştırmalar için istatistiksel olarak analiz edildi Bulgular: 27 hastanın verilerine ulaşıldı. Bu hastaların %40,7'si (n=11) kadın, %59,3'ü (n=16) erkekti. Hastaların yaş ortalaması 74,81 (65 ile 88 arasında) olarak belirlendi. Yoğun bakım ünitesinde 5 erkek, 8 kadın olmak üzere 13 hasta izlendi. 6 hastada ölüm yaşandı ve bunların tamamı yoğun bakım ünitesine yatırılan hastalardan oluştu. Cinsiyete göre ölüm oranları karşılaştırıldığında erkek hastalarda bu oran %18,8, kadın hastalarda ise %27,3 oldu. 27 hastanın tamamında en az bir komorbidite mevcuttu. Mortalite yaşayan hastaların en az iki komorbiditesi vardı. On iki hasta ameliyat edilmedi. Sonuç: Geriatrik hastaların acil değerlendirmesinde, tanı sonrası komorbiditeler göz önünde bulundurularak hızlı tanı konulmalı, yoğun bakım gerektiren veya normal odalarda izlenecek hastalar için takip ve tedaviler multidisipliner olarak ayarlanmalıdır.
Keywords
References
- World Population Prospects 2019: Highlights. Https://population.un.org/wpp/Publications/Files/ WPP2019_10KeyFindings.pdf. (Erişim Tarihi:18.11.2020)
- TÜİK nüfus projeksiyonları 2018-2080. https://www. tuseb.gov.tr/enstitu/tacese/haber_detay.php?id=72. (ErişimTarihi:18.11.2020)
- Çilingir D, Bayraktar N. Günübirlik cerrahi süreci ve hemşirelik bakımı. Hacettepe Üniversitesi Hemşirelik Yüksekokulu Dergisi 2006;13:69-81.
- Blansfield JA, Clark SC, Hofmann MT, et al. Alimentary tract surgery in the nonagenarian: Elective vs. emergent operations. J Gast Surg. 2004;8:539-42.
- Baum SA, Rubenstein LZ. Old people in the emergency room: Age-related differences in emergency department use and care. J Am Geriatr Soc. 1987;35(5):398-404.
- Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinicalcourse of abdominal pain in senior patients: A prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60(8):1071-6.
- Marco CA, Schoenfeld CN, Keyl PM, Menkes ED, Doehring MC. Abdominal pain in geriatric emergency patients: Variables associated with adverse outcomes. Acad Emerg Med 1998;5(12):1163-8.
- Birnbaumer D. Abdominal pain in the elderly patient. http://www.epmonthly.com/cme/current-issue/abdominal-pain-in-theelderly-patient-/1/ (accessed on March 2013).
- Hendrickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Med Clin N Am. 2003;21(4):937-69
- McNamara R. Abdominal pain in elderly. In: Tintinalli JE, Kelen GD, Stapczynski JS, (eds). Emergency Medicine. 6 th ed. New York: Mc Graw Hill; 2004:501-5
- Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin N Am. 2006;24(2):371-88
- Ağalar F, Özdoğan M, Daphan ÇE, Topaloğlu S, Sayek İ. The results of surgical treatment in the elderly acute abdomen patients. Turkish Journal of Geriatrics. 1999;2:1-4.
- Reiss R, Deutsch AA. Emergency Abdominal Procedures in Patients Above 70. J Gerontology. 1985; 40:154
- Fenyö G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am J Surg. 1982;143(6):751-754.
- Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006;74:1537-44.
- Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003;46:111-6.
- Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52.
- Adesunkanmi AR, Agbakwuru EA, Badmus TA. Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria. East Afr Med J. 2000;77:31-3.
- Marco CA, Schoenfeld CN, Keyl PM, Menkes ED, Doehring MC. Abdominal pain in geriatric emergency patients: variables associated with adverse outcomes. Acad Emerg Med. 1998;5:1163-8.
- Rigberg D, Cole M, Hiyama D, McFadden D. Surgery in the nineties. Am Surg. 2000;66:813-6.
- Nursal TZ, Hamaloğlu E. Gastrointestinal surgery in the elderly. Turkish Journal of Geriatrics. 1999;2:22-5.
- Potts FE, Vukov LF. Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond. J Gerontol A Biol Sci Med Sci. 1999;54:55-8.
- Mamode N, Pickford I, Leiberman P. Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg 1999;165:203-8.
Details
| Primary Language | English |
|---|---|
| Subjects | Aged Health Care |
| Journal Section | Research Article |
| Authors | |
| Publication Date | March 29, 2024 |
| Submission Date | February 3, 2024 |
| Acceptance Date | March 2, 2024 |
| Published in Issue | Year 2024 |