Emergency general surgery (EGS) in elderly patients carries significant risk of both morbidity and mortality. The growing population of patients over 65 years of age suggests General Surgeons will be tasked with managing increasing numbers of frail and co-morbid patients who are at higher risk compared to younger and non-emergent patients.

An electronic literature search of PubMed, MEDLINE, EMBASE and the Cochrane Database of Collected Research was performed from 1990 to 2016. The search included “frail,” “elderly,” “octogenarian,” “old” and was limited to English papers within emergency general surgery. Observational and experimental studies were included if they included patients over 65 years of age, case reports were excluded. The New-Castle Ottawa scale was used to assess study quality.

In twelve studies which met inclusion criteria five were case series, six retrospective cohorts, including two utilizing ACS-NSQIP and one prospective cohort study. Case composition indicated a higher proportion of small/large bowel surgery compared to non-elderly patients. Mortality after EGS ranged from 12-38% with morbidity ranging from 28-70%. In studies directly comparing patients older than 65 years of age to younger patients undergoing EGS, mortality was almost three times higher. 

Elderly patients undergoing EGS should be considered higher risk than younger patients not only based on age but on frailty and functional status. Case composition, high failure to rescue rate and delayed diagnosis may help explain the elevated mortality rate. Further study is required to identify potentially modifiable risk factors and potential process measures to improve outcomes.

Emergency general surgery in the elderly: A systematic review