@article {8246, title = {Predictors of Mortality Up to 1 Year After Emergency Major Abdominal Surgery in Older Adults.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, month = {2015 Dec}, pages = {2572-2579}, publisher = {63}, abstract = {

OBJECTIVES: To identify factors associated with mortality in older adults 30, 180, and 365~days after emergency major abdominal surgery.

DESIGN: A retrospective study linked to Medicare claims from 2000 to 2010.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Medicare beneficiaries aged 65.5 enrolled in the HRS from 2000 to 2010 with at least one urgent or emergency major abdominal surgery and a core interview from the HRS within 3~years before surgery.

MEASUREMENTS: Survival analysis was used to describe all-cause mortality 30, 180, and 365~days after surgery. Complementary log-log regression was used to identify participant characteristics and postoperative events associated with poorer survival.

RESULTS: Four hundred individuals had one of the urgent or emergency surgeries of interest, 24\% of whom were aged 85 and older, 50\% had coronary artery disease, 48\% had cancer, 33\% had congestive heart failure, and 37\% experienced a postoperative complication. Postoperative mortality was 20\% at 30~days, 31\% at 180~days, and 34\% at 365~days. Of those aged 85 and older, 50\% were dead 1~year after surgery. After multivariate adjustment including postoperative complications, dementia (hazard ratio (HR)~=~2.02, 95\% confidence interval (CI)~=~1.24-3.31), hospitalization within 6~months before surgery (HR~=~1.63, 95\% CI~=~1.12-2.28), and complications (HR~=~3.45, 95\% CI~=~2.32-5.13) were independently associated with worse 1-year survival.

CONCLUSION: Overall mortality is high in many older adults up to 1~year after undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival.

}, issn = {1532-5415}, doi = {10.1111/jgs.13785}, author = {Cooper, Zara and Susan L Mitchell and Rebecca Jean Gorges and Ronnie A Rosenthal and Stuart R Lipsitz and Amy Kelley} }