Emergency surgery in the elderly: the balance between function, frailty, fatality and futility
Open accessAbstract
Becoming old is considered a privilege and results from the socioeconomic progress and improvements in health care systems worldwide. However, morbidity and mortality increases with age, and even more so in acute onset disease. With the current prospects of longevity, a considerable number of elderly patients will continue to live with good function and excellent quality of life after emergency surgical care. However, mortality in emergency surgery may be reported at 15-30%, doubled if associated with complications, and notably higher in patients over 75 years. A number of risks associated with death are reported, and a number of scores proposed for prediction of risk. Frailty, a decline in the physiological reserves that may make the person vulnerable to even the most minor of stressful event, appears to be a valid indicator and predictor of risk and poor outcome, but how to best address and measure frailty in the emergency setting is not clear. Futility may sometimes be clearly defined, but most often becomes a borderline decision between ethics, clinical predictions and patient communication for which no solid evidence currently exists. The number and severity of other underlying condition(s), as well as the treatment alternatives and their consequences, is a complex picture to interpret. Add in the onset of the acute surgical disease as a further potential detrimental factor on function and quality of life - and you have a perfect storm to handle. In this brief review, some of the challenging aspects related to emergency surgery in the elderly will be discussed. More research, including registries and trials, are needed for improved knowledge to a growing health care challenge.
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Elderly, frail, and very co-morbid patients may not be surgical candidates, nor candidates for active intervention.
“Elderly, frail, and very co-morbid patients may not be surgical candidates, nor candidates for active intervention.”
From Acute mesenteric ischaemia (2023) · cites this paper as [19]
In “Strategies for optimal care” (page unavailable), the paper says patients unlikely to benefit from or tolerate surgery should be considered for other treatment options. It also says aggressive life-prolonging care can do more harm than good in some cases. This supports the possibility that surgery is inappropriate, but not the broader suggestion that such patients may be candidates for no active intervention: the paper discusses less invasive treatment and palliation instead. (LLM, conf=0.82)
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- Authors
- Søreide, K., & Desserud, K. F.
- Affiliations
- Stavanger University Hospital (NO)
- Corresponding author
- Søreide, Kjetil
- ORCID
- Søreide, Kjetil
- Venue
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
- Published
- 2015-02-03
- Volume
- 23
- Issue
- 1
- Pages
- 10-10
- ISSN
- 1757-7241 (ISSN-L)
- PMC
- PMC4320594
- OpenAlex
- W2109776710
- Cited by
- 103
- References
- 55
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 5 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 9 · 2019: 11 · 2018: 8 · 2017: 17 · 2016: 11 · 2015: 5
- FWCI
- 6.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- emergency surgery, elderly patients, frailty, postoperative mortality, risk scoring, futility, quality of life, geriatric surgery, patient communication, acute surgical diseases
- MeSH terms
- Aged, Female, Humans, Male, Postoperative Complications, Quality of Life, Risk Factors, Surgical Procedures, Operative, Geriatric Assessment, Frail Elderly, Hospital Mortality, Medical Futility, Recovery of Function, Quality Improvement
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