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Cited by 103Frailty in Older AdultsCardiac, Anesthesia and Surgical OutcomesTrauma and Emergency Care Studies

The DOI matches its Crossref record; 55 of the 55 references it cites were found in a registry or an index.

Emergency surgery in the elderly: the balance between function, frailty, fatality and futility

Open access
Søreide, Kjetil, Desserud, Kari F·2015·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
DOI 10.1186/s13049-015-0099-xPMC PMC4320594
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Abstract

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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Figure 1 Life-expectancy at birth in Norway. Data based on numbers from Statistics Norway (http://www.ssb.no).
Figure 1 Life-expectancy at birth in Norway. Data based on numbers from Statistics Norway (http://www.ssb.no).CC BY · PubMed Central
Figure 2 Projected number of elderly per age-group and both genders. Data from Folkehelseinstituttet (copyright Norwegian Institute of Public Health) and produced with permission.
Figure 2 Projected number of elderly per age-group and both genders. Data from Folkehelseinstituttet (copyright Norwegian Institute of Public Health) and produced with permission.CC BY · PubMed Central
Figure 3 Steps to consider in optimal care pathways as framework for clinical care improvement and research targets.
Figure 3 Steps to consider in optimal care pathways as framework for clinical care improvement and research targets.CC BY · PubMed Central
Figure 4 Depicted increase in mortality rates per age group after emergency laparotomy. Data are derived from the UK Emergency Laparotomy Network.
Figure 4 Depicted increase in mortality rates per age group after emergency laparotomy. Data are derived from the UK Emergency Laparotomy Network.CC BY · PubMed Central

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Metadata

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
Publisher
Springer Science and Business Media LLC
Published
2015-02-03
Volume
23
Issue
1
Pages
10-10
ISSN
1757-7241 (ISSN-L)
DOI
10.1186/s13049-015-0099-x
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
Licence
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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