Juárez CD, Hurtado DJL, Escamilla OA, Miranda GO

Language: Spanish
References: 17
Page: 120-129
PDF size: 74.27 Kb.

ABSTRACT

Objective:The purpose of this work was to analyze, in a group of patients older than 60 years (senile), the most frequent surgical problems, those procedures used to solve them, the relationship between morbidity and mortality and increasing age with either emergency or elective surgical procedures.
Setting:Second level health care hospital.
Type of study:Observational, retrospective, with no control group.
Patients and methods:Records of 653 patients 60 years old, in the department of surgery of a second level health care hospital were reviewed. Frequency of occurrence of surgical problems, the procedures used to solve them, as a whole or by decades, as well as the relationship between general morbidity and mortality in all groups, and either elective or emergency surgery, were all studied.
Statistical analysis:Frequency simple analysis and Chi square for inferences between morbidity and mortality were used.
Results:Fifty-nine percent of the 653 patients were females, 58.6% were between 60 and 69 years old. In general, cholelithiasis was the diagnosis most commonly observed (27.25%), followed by inguinal hernias (9%), and acute appendicitis (8.8%). Bile duct disease was the most common cause of surgical indication in this group of patients, since both cholelithiasis and choledocolithiasis accounted for 32.3% of all patients operated. Thus, cholecistectomy, with or without bile duct exploration, was the surgical procedure most commonly performed. The same behavior was observed in those patients grouped by decades. There were a larger number of emergency surgeries as age increased, which was not directly associated to either morbi-mortality, emergency surgery, or age itself. Surgical wound infection was the complication most commonly encountered, and intrabdominal sepsis was the most common cause of death. There was a statistical inference between morbi-mortality and emergency-elective surgery. Global morbidity was 9.18%, and mortality was 2.54%, which was not directly related with age increase in these patients.
Conclusion:Diagnosis, elective treatment, and younger age reduced morbi-mortality.

REFERENCES

1. . Reiss R, Deutsch A, Nudelman I. Surgical problems in octogenarians: epidemiological analysis of 1,803 consecutives admissions. World J Surg 1992; 16: 1017-20; discussion 1020-1.

2. Reiss R, Deutsch A, Aliashiv A. Decision-making process in abdominal surgery in the geriatric patients. World J Surg 1983; 7: 522-6.

3. Muñoz E, Sterman H, Goldstein J, Friedman R, Cohen J, Wise L. Financial risk and hospital cost for elderly patients in non-age stratified surgical DRGS. Am Surg 1988; 54: 535-8.

4. Wilder RJ, Fishbein RH. Operative experience with patients over 80 years of age. Surremenna Meditsina 1961; 113: 205-12.

5. Gardner B, Palasti S. A comparison of hospital costs and morbidity between octogenarians and other patients undergoing general surgical operations. Surg Gynecol Obstet 1990; 171: 299-304.

6. Djokovic JL, Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979; 242: 2301-6.

7. Warner MA, Hosking MP, Lobdell CM, Offord KP, Melton LJ 3rd. Surgical procedures among those greater than or equal to 90 years for age. A population-based study in Olmsted County, Minnesota, 1975-1985. Ann Surg 1988; 207: 380-6.

8. Marshall WH, Fahey PJ. Operative complications and mortality in patients over 80 years age. Arch Surg 1964; 88: 896-904.

9. Plewa MC. Respuesta inmunológica alterada e infecciones especiales en el anciano. Clin Med Urg Norteam 1990; 2: 205-22.

10. Rorbaek-Madsen M, Dupont G, Kristensen K, Holm T, Sorensen J, Dahger H. General surgery in patients aged 80 years and older. Br J Surg 1992; 79: 1216-8.

11. Samiy AH. Manifestaciones clínicas de la enfermedad en ancianos. Clin Med Norteam 1983; 67: 329-40.

12. Altman DF. Enfermedades gastrointestinales en ancianos. Clin Med Norteam 1983; 67: 421-32.

13. Loberant N, Rose C. Características de las imágenes de diagnóstico en el paciente geriátrico que acude al servicio de urgencias. Clin Med Urg Norteam 1990; 2: 409-49.

14. Fenyo G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am J Surg 1982; 143: 751-4.

15. Balsano N, Cayten CG. Urgencias quirúrgicas abdominales. Clin Med Urg Norteam 1990; 2: 451-64.

16. Garza-Flores JH, Basurto KE, Vázquez OR. Cirugía en ancianos. Cir Gen 1997; 19: 32-6.

17. Juárez CD, Silva RO, Huerta HA. Síndrome abdominal agudo en el paciente anciano. Cir Gen 1996; 18: 190-3