Outcomes of Emergency Surgery for Generalized Peritonitis in the Octogenarian

Shinsuke Saisho, Ichiro Suto, Izumi Eda, Koya Suemitsu and Akio Ohtsuka

Department of Surgery, Unnan Municipal General Hospital

Background: With the aging society accelerating in numbers, the frequency of surgery for elderly patients has increased. This study evaluated the efficacy and safety of emergency surgery for generalized peritonitis in the octogenarian. Subject: Between January 1993 and December 2004, 129 patients underwent emergency surgery for generalized peritonitis in our institution. Of those, 31 patients (24.0%) were octogenarians over 80 years old (Elderly group). We retrospectively compared this group with 25 patients in their 70's (Non-elderly (A) group) and 24 patients in their 60's (Non-elderly (B) group). Results: As for the site of perforation, the upper gastrointestinal tract was as high as 58.3% in the non-elderly (B) group, while in the non-elderly (A) and elderly groups, the appendix or colorectum comprised about 60%. The rates of preoperative morbidity in the elderly, non-aged (A), and non-aged (B) groups were 90.3%, 84.0%, and 75.0%, respectively. The cardiac morbidity rate was significantly higher in patients over 70 years old than in patients in their 60's. There were no other significant differences in the preoperative course, preoperative blood test, surgical procedure, surgical duration or volume of blood loss. The incidence of patients requiring postoperative mechanical ventilation or administration of catecholamines was higher and the postoperative hospital stay tended to be longer for elderly patients. The rate of postoperative morbidity, especially major complications, was also higher for elderly patients. In each group, the overall survival-discharge rate was 70-80%, and there was no significant difference in surgical-death or postoperative hospital-death. However, in the elderly group only, we recognized a decline in ADL (activities of daily living) in 26.1% of the surviving patients at discharge. Conclusions: We concluded that emergency surgery for generalized peritonitis can be performed safely for octogenarians, resulting in a prognosis equal to that of non-elderly patients. We recognize patients over 70 years old as "the elderly" patients, and should perform strict perioperative management, especially the management of breathing and circulatory dynamics. For the octogenarian, prevention of postoperative ADL decline is an important problem that remains to be resolved.

Key words
generalized peritonitis, octogenarian, prognosis, ADL decline

Reprint requests
Shinsuke Saisho Department of Thoracic Surgery, Shizuoka Cancer Center
1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777 JAPAN

Accepted
September 28, 2005

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