Acil Abdominal Cerrahi Sonrası Mortalite ve Komplikasyon Oranları: Geriatrik Yaş Gruplarında Retrospektif Bir Analiz

Abstract

Giderek artan yaşlı nüfus, acil abdominal cerrahi sonrasında yüksek morbidite ve mortalite riskiyle karşı karşıyadır. Yaş sıklıkla bir risk faktörü olarak kabul edilse de, olumsuz sonuçların esasen kronolojik yaştan mı yoksa eşlik eden perioperatif değişkenlerden mi kaynaklandığı halen tartışmalıdır. Gereç ve Yöntemler: 2015–2024 yılları arasında Düzce Üniversitesi hastanesinde acil abdominal cerrahi geçiren ≥65 yaş hastalar retrospektif olarak incelendi. Hastalar üç yaş grubuna ayrıldı (65–74, 75–84, ≥85 yaş). Demografik, klinik, perioperatif ve postoperatif veriler toplandı. Otuz günlük mortaliteyi öngören faktörleri belirlemek için çok değişkenli lojistik regresyon analizi uygulandı. Bulgular: Çalışmaya toplam 98 hasta dahil edildi (65–74 yaş, n=45; 75–84 yaş, n=35; ≥85 yaş, n=18). Genel 30 günlük mortalite oranı %14,3 olup alt gruplarda sırasıyla %15,6, %20,0 ve %16,7 olarak bulundu. Postoperatif komplikasyonlar 29 hastada (%29,6) görüldü ve 34 hasta (%34,7) yoğun bakım ünitesine kabul edildi. Çok değişkenli analizde ileri yaş, yüksek ASA skoru ve uzamış ameliyat süresi bağımsız olarak mortalite riskini artırırken, komorbidite yükü yalnızca sınırda bir etki gösterdi. Sonuç: Geriatrik hastalarda acil abdominal cerrahi, belirgin morbidite, yoğun bakım ihtiyacı ve mortalite ile ilişkilidir. Yaş mortalite riskine katkıda bulunsa da bu etki sınırlı olup ASA durumu ve ameliyat süresi ile yakından ilişkilidir. Bu kırılgan hasta grubunda doğru risk sınıflandırması ve optimal perioperatif bakım için hem kronolojik yaşın hem de perioperatif faktörlerin bütüncül olarak değerlendirilmesi gereklidir.

Keywords

• Acil abdominal cerrahi
• geriatrik hastalar
• postoperatif komplikasyonlar
• mortalite
• risk faktörleri

Mortality and Complication Rates After Emergency Abdominal Surgery: A Retrospective Analysis in Geriatric Age Groups

Abstract

Aim: The growing geriatric population faces high morbidity and mortality after emergency abdominal surgery. While age is often regarded as a risk factor, whether chronological age itself or accompanying perioperative variables primarily drive adverse outcomes remains debated. Material and Methods: Patients aged ≥65 years who underwent emergency abdominal surgery at Düzce University between 2015 and 2024 were retrospectively analyzed. Patients were stratified into three age groups (65–74, 75–84, ≥85 years). Demographic, clinical, perioperative, and postoperative data were collected. Multivariable logistic regression was used to identify predictors of 30-day mortality. Results: A total of 98 patients were included (65–74 years, n=45; 75–84 years, n=35; ≥85 years, n=18). The overall 30-day mortality rate was 14.3%, with subgroup rates of 15.6%, 20.0%, and 16.7%, respectively. Postoperative complications occurred in 29 patients (29.6%), and 34 patients (34.7%) required ICU admission. In multivariable analysis, advancing age, higher ASA score, and prolonged operative time were independently associated with increased mortality risk, whereas comorbidity burden showed only a borderline effect. Conclusion: Emergency abdominal surgery in geriatric patients is associated with substantial morbidity, ICU utilization, and mortality. Although age contributed to mortality risk, its effect was modest and closely interrelated with ASA status and operative duration. A comprehensive assessment that incorporates both chronological age and perioperative factors is essential for accurate risk stratification and optimal perioperative care in this vulnerable population.

Keywords

• Emergency abdominal surgery
• geriatric patients
• postoperative complications
• mortality
• risk factors

References

1. 1. Jones CH, Dolsten M. Healthcare on the brink: navigating the challenges of an aging society in the United States. NPJ Aging. 2024;10(1):22. doi:10.1038/s41514-024-00148-2.
2. 2. Ismail Z, Ahmad WIW, Hamjah SH, Astina IK. The impact of population ageing: a review. Iran J Public Health. 2021;50(12):2451-60. doi:10.18502/ijph.v50i12.7927.
3. 3. Tenchov R, Sasso JM, Wang X, Zhou QA. Aging hallmarks and progression and age-related diseases: a landscape view of research advancement. ACS Chem Neurosci. 2024;15(1):1-30. doi:10.1021/acschemneuro.3c00531.
4. 4. Sağlam S, Arıcan M, Karaduman ZO, Yücel MO, Değirmenci E, Uludağ V. The characteristics and outcomes of contralateral non-concurrent hip fractures: a retrospective study in geriatric patients. 2024;60(6):928. doi:10.3390/medicina60060928.
5. 5. Sağlam S, Ersen O. Tüzün HY, Yıldız C. Advantages of distal unlocked proximal femoral nails in the treatment of stable intertrochanteric fractures in geriatric patients: a single-center comparative randomized study. Geriatr Orthop Surg Rehabil. 2025;16:21514593251327910. doi:10.1177/21514593251327910.
6. 6. Mohseni S, Joseph B, Peden CJ. Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade. Eur J Trauma Emerg Surgery. 2022;48(2):799-810. doi:10.1007/s00068-021-01647-7.
7. 7. Hacım NA, Akbaş A, Ulgen Y, Vartanoglu Aktokmakyan T, Meric S, Tokocin M, et al. Association of preoperative risk factors and mortality in older patients following emergency abdominal surgery: a retrospective cohort study. Ann Geriatr Med Res. 2021;25(4):252-9. doi:10.4235/agmr.21.0104.
8. 8. Kim HS, Kim HI. Analysis of prognostic factors for postoperative complications and mortality in elderly patients undergoing emergency surgery for intestinal perforation or irreversible intestinal ischemia. Ann Surg Treat Res. 2023;105(4):198-206. doi:10.4174/astr.2023.105.4.198.

9. 9. Takama T, Okano K, Kondo A, Akamoto S, Fujiwara M, Usuki H, et al. Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer. 2015;18(3):653-61. doi:10.1007/s10120-014-0387-6.
10. 10. Silva DJN, Casimiro LGG, Oliveira MIS, Ferreira L, Abelha F. The very elderly surgical population in a critically ill scenario: clinical characteristics and outcomes. Braz J Anesthesiol. 2020;70(1):3-8. (in Portuguese). doi:10.1016/j.bjan.2019.10.001.
11. 11. Lee SH, Kim JY, Kim TH, Ju SM, Yoo JW, Lee SJ, et al. Retrospective analysis of long-term survival in very elderly (age ≥80) critically ill patients of a medical intensive care unit at a Tertiary Care Hospital in Korea. Tuberculosis and respiratory diseases. 2020;83(3):242-7. doi:10.4046/trd.2019.0032.
12. 12. Miniksar ÖH, Özdemir M. Clinical features and outcomes of very elderly patients admitted to the intensive care unit: a retrospective and observational study. 2021;25(6):629-34. doi:10.5005/jp-journals-10071-23846.
13. 13. Shah P, Saran A, Das S. Analysis of the American Society of Anesthesiologists physical status scale reliability in anaesthesia practice: an observational study. Turkish J Anaesthesiol Reanim. 2019;48(5):385-90. doi:10.5152/TJAR.2019.50146.
14. 14. Yayan J, Biancosino C. Age-related differences in clinical outcomes of patients with Pleural Empyema: a retrospective single-center study. Geriatrics (Basel). 2025;10(4):95. doi:10.3390/geriatrics10040095.
15. 15. Ay N, Derbent A, Şahin AS, Yalcin N, Çelik M. Variables affecting mortality rates in patients undergoing emergency abdominal surgery: a retrospective cross-sectional study. Ulus Travma Acil Cerrahi Derg. 2023;29(4):505-13.10.14744/tjtes.2022.01264.
16. 16. Cooper Z, Scott JW, Rosenthal RA, Mitchell SL. Emergency major abdominal surgical procedures in older adults: a systematic review of mortality and functional outcomes. J Am Geriatr Soc. 2015;63(12):2563-71. doi:10.1111/jgs.13818.
17. 17. Cinar F, Parlak G, Aslan FE. The effect of comorbidity on mortality in elderly patients undergoing emergencyabdominal surgery: a systematic review and metaanalysis. Turk J Med Sci. 2021;51(1):61-7. doi:10.3906/sag-2001-27.
18. 18. Burzyńska M, Kopiec T, Pikala M. Mortality Trends due to Falls in the Group of People in Early (65-74 Years) and Late (75+) Old Age in Poland in the Years 2000-2020. nt J Environ Res Public Health. 2023;20(6):5073. doi:10.3390/ijerph20065073.
19. 19. Xu J, Liao J, Yan Q, Jiao J, Hu N, Zhang W, et al. Trends analysis of cancer incidence, mortality, and survival for the elderly in the United States, 1975-2020. 2024;13(15):e70062. doi:10.1002/cam4.70062.
20. 20. Saetang M, Kunapaisal T, Wasinwong W, Boonthum P, Sriyanaluk B, Nuanjun K. Predictors associated with Clavien-Dindo complications in lung cancer surgery: a retrospective cohort study. PLoS One. 2024;19(12):e0316214. doi:10.1371/journal.pone.0316214.
21. 21. Ong M, Guang TY, Yang TK. Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: a single center experience. World J Gastrointest Surg. 2015;7(9):208-13. doi:10.4240/wjgs.v7.i9.208.
22. 22. Fuchs L, Chronaki CE, Park S, Novack V, Baumfeld Y, Scott D, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care medicine. 2012;38(10):1654-61. doi:10.1007/s00134-012-2629-6.
23. 23. Yu W, Ash AS, Levinsky NG, Moskowitz MA. Intensive care unit use and mortality in the elderly. J Gen Intern Med. 2000;15(2):97-102. doi:10.1046/j.1525-1497.2000.02349.x.
24. 24. Hackett NJ, De Oliveira GS, Jain UK, Kim JYS. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015;18:184-90. doi:10.1016/j.ijsu.2015.04.079.
25. 25. Chu C-L, Chiou H-Y, Chou W-H, Chang P-Y, Huang Y-Y, Yeh H-M. Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data. BMC Geriatr. 2017;17(1):245. doi:10.1186/s12877-017-0629-7.
26. 26. Luo X, Liu B, Li F, Zheng S, Li Y, Yang L, et al. The relationship between anesthetic technique and thirty-day mortality in patients undergoing noncardiac- and nonneurosurgery: a retrospective, propensity score-matched cohort study. Int J Surg. 2020;77:120-7. doi:10.1016/j.ijsu.2020.03.043.