Abstract
Purpose
The population in developing countries is aging and the number of octogenarians is expected to increase in the future at an alarmingly fast rate. This paper evaluates the surgical outcomes of emergency colorectal resections among Asian octogenarians.
Methods
We conducted a retrospective review of all octogenarians and older, who had an emergency colorectal resection performed between February 1996 to December 2001.
Results
Fifty-eight emergency colorectal resections were performed in patients with a median age of 83 years. The indications for surgery were colorectal cancer (74%) and complicated diverticular disease (12%). The most common presentation was an intestinal obstruction (72%). Fifty-one (88%) of the patients had comorbidities. Forty-five percent of patients had an American Society of Anesthesiologists (ASA) score of I and II, while 55% had a score of III and IV. Consultants performed 53% of the procedures. The mean surgical time was 156 min. Hartmann’s procedure was the most common procedure performed (43%). There were 16 (28%) mortalities. The postoperative morbidity was 81%. The only factor impacting outcome was a high ASA score of III and IV. The median length of stay was 17.5 (range 3–108) days.
Conclusions
The mortality and morbidity of emergency colorectal resections among Asian octogenarians are high and can be predicted by their ASA status.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schoon IM, Arvidsson S. Surgery in patients aged 80 years and over. Eur J Surg 1991;157:251–255.
Bufalari A, ferri M, Cao P, Cirocchi R, Moggi L. Surgical care in octogenarians. Br J Surg 1996;83:1783–1787.
Walsh TH. Audit of outcome of major surgery in the elderly. Br J Surg 1996;83:92–97.
Anderson JH, Hole D, McArdle CS. Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 1992;79:706–709.
Mulcahy HE, Patchett SE, Daly L, O’Donoghue DR. Prognosis of elderly patients with large bowel cancer. Br J Surg 1994;81:419–421.
Morel PH, Egeli RA, Wachtl S, Rohner A. Results of operative treatment of gastrointestinal tract tumors in patients over 80 years of age. Arch Surg 1989;124:662–664.
Spivak H, Maele DV, Friedman I, Nussbaum M. Colorectal surgery in octogenarians. J Am Coll Surg 1996;183:46–50.
Nyam DCNK, Tang CB, Ang M, Ho YH, Leong AFPK, Seow-Choen F. Surgery for colorectal cancer in the octogenarian. Tech Coloproctol 1999;3:23–26.
Lee Y-S. Diverticular disease of the large bowel in Singapore: An autopsy study. Dis Colon Rectum 1986;29:330–335.
Chia JG, Wilde CC, Ngoi SS, Goh PM, Ong CL. Trends of diverticular disease of the large bowel in a newly developed country. Dis Colon Rectum 1991;34:498–501.
Huang J, Seow A, Shi CY, Lee HP. Colorectal carcinoma among ethnic Chinese in Singapore: trends in incidence rate by anatomical subsite from 1968 to 1992. Cancer 1999;85:2519–2525.
Chia KS, Lee HP, Seow A. Shanmugaratnam K. Trends in cancer incidence in Singapore 1968–1992. Singapore Cancer Registry, Report No 4; 1996.
Pavlidis TE, Marakis G, Ballas K, Rafailidis S, Psarras K, Pissas D, et al. Safety of bowel resection for colorectal surgical emergency in the elderly. Colorectal Dis 2006;8:657–662.
Arnaud JP, Schloegal M, Ollier JC, Adcoff M. Colorectal cancer in patients over 80 years of age. Dis Colon Rectum 1991;34:896–898.
Tan E, Tilney H, Thompson M, Smith J, Tekkis PP. The United Kingdom National Bowel Cancer Project — epidemiology and surgical risk in the elderly. Eur J Cancer 2007;43:2285–2294.
Poon RTP, Law WL, Chu KW, Wong J. Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg 1998;85:1539–1542.
Heriot AG, Tekkis PP, Smith JJ, Cohen CRG, Montgomery A, Audisio RA, et al. Prediction of postoperative mortality in elderly patients with colorectal cancer. Dis Colon Rectum 2006;49:816–824.
Boyd JB, Bradford B Jr, Watne AL. Operative risk factors of colon resection in the elderly. Ann Surg 1980;192:743–746.
Schein M, Decker G. The Hartmann procedure: Extended indications in severe intraabdominal infection. Dis Colon Rectum 1998;31:126–129.
Seah DW, Ibrahim S, Tay KH. Hartmann procedure: Is it still relevant today? Aust N Z. J Surg 2005;75:436–440.
Desai DC, Brennan EJ, Reilly JF, Smink RD Jr. The utility of the Hartmann Procedure. Am J Surg 1998;175:152–155.
Biondo S, Jaurrieta E, Marti Rague J, Ramos E, Deiros M, Moreno P, et al. Role of resection and primary anastomosis of the left colon in the presence of peritonitis. Br J Surg 2000;87:1580–1584.
Leong QM, Koh DC, Ho CK. Emergency Hartmann’s procedure: morbidity, mortality and reversal rates among Asians. Tech Coloproctol 2008;12:21–25.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Leong, Q.M., Aung, M.O., Ho, C.K. et al. Emergency colorectal resections in Asian octogenarians: Factors impacting surgical outcome. Surg Today 39, 575–579 (2009). https://doi.org/10.1007/s00595-008-3925-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-008-3925-1