Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: A retrospective cohort study

• Emergency general surgery in octogenarians is generally high risk.
• Patients should be judged on physiological fitness for surgery rather than by age.
• COPD & increasing ASA score are significant & independent predictors of mortality.

Introduction: Elderly patients are often judged to be fit for emergency surgery based on age alone. This study identified risk factors predictive of in-hospital mortality amongst octogenarians undergoing emergency general surgery. Methods: A retrospective review of octogenarians undergoing emergency general surgery over 3 years was performed. Parametric survival analysis using Cox multivariate regression model was used to identify risk factors predictive of in-hospital mortality. Hazard ratios (HR) and corresponding 95% confidence interval were calculated. Results: Seventy-three patients with a median age of 84 years were identified. Twenty-eight (38%) patients died post-operatively. Multivariate analysis identified ASA grade (ASA 5 HR 23.4 95% CI 2.38–230, p = 0.007) and chronic obstructive pulmonary disease (COPD) (HR 3.35 95% CI 1.15–9.69, p = 0.026) to be the only significant predictors of in-hospital mortality. Conclusions: Identification of high risk surgical patients should be based on physiological fitness for surgery rather than chronological age.