Long-term Outcomes Following Emergency General Surgery in Older Adults

Introduction: Emergency general surgery (EGS) conditions represent a large and growing burden for patients and healthcare systems alike, particularly among older adults (age ≥ 65). While the short-term risks of EGS among older adults have been studied, little is known about long-term functional outcomes in this population. This knowledge gap raises questions about the pursuit of high-intensity EGS care in older adults, limits surgeons’ abilities to counsel patients, and may lead to decision making that is not patient-centred. Methods: We developed a population-based cohort of older adults hospitalized in Ontario from 2006-2016 for one of eight EGS diagnoses. We then matched this cohort to a control group based on demographics and health status and compared long-term function, measured as time spent alive and living at home, between groups over five years. Next, we used a multivariable Cox regression model to determine the association between timely primary care physician (PCP) follow-up after EGS and long-term function. Finally, we used a multistate model to describe the functional trajectories experienced by older adults in the five years following EGS. Results: We identified 105,925 older adults with an EGS admission. While EGS cases experienced less time alive and at home compared to controls (mean 43 vs. 50 months, p<0.001), 57% remained alive and at home after five years. Nonetheless, older EGS patients were at higher risk for nursing home admission or death for at least five years compared to controls (HR 1.17-5.11). Timely follow-up with a PCP was associated with a reduced risk of nursing home admission or death compared to no follow-up (HR 0.87, 95% CI 0.84–0.91). Over the five years following EGS admission, 32% of older adults experienced functional decline requiring new assistance from home care services; functional recovery ranged from 36-43% annually over five years. Conclusions: The majority of older adults have favorable functional outcomes following EGS admission suggesting that high-intensity EGS care should not be withheld based on age alone. Nonetheless, our findings indicate that older adults require long-term supports following EGS to mitigate the risk of functional decline and recover from temporary losses of function when they occur.

Department dc:contributor.department

Health Policy, Management and Evaluation

Year dc:date.issued

2022

Author dc:creator

• Guttman, Matthew P.

Advisors dc:contributor.advisor

• Nathens, Avery B
• Haas, Barbara

• Acute care surgery
• Function
• Long-term outcomes
• Older adults
• Surgery

Handle dc:identifier.uri

http://hdl.handle.net/1807/140355

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/140355