Morbidity and predictors of mortality in nonagenarians undergoing emergency surgery

José M. Rabanal-Llevot, Department of Anesthesia and Surgical Critical Care, Hospital Universitario Marqués de Valdecilla, Santander; Department of Medical and Surgical Sciences, Medical School, Universidad de Cantabria, Cantabria; Spain
José M. Lage-Sánchez, Department of Urology Service, Hospital Universitario de Poniente, Almeria, Spain
Dieter Morales-García, Department of General Surgery, Hospital Universitario Virgen de la Victoria; Department of Surgery, Medical School, Universidad de Málaga, Malaga; Spain

Background: Data on perioperative outcomes in nonagenarians remain limited. Objective: The objective of the study was to evaluate morbidity and short- and mid-term mortality in nonagenarians undergoing emergency non-cardiac surgery and to identify predictors of 6-month mortality. Material and methods: We conducted a retrospective single-center cohort study including all patients aged ≥ 90 years who underwent emergency non-cardiac surgery. Demographic variables, comorbidities, surgical characteristics, post-operative complications (Clavien-Dindo), and mortality (in-hospital, 30-day, and 6-month) were recorded. Logistic regression was used to identify predictors of 6-month mortality. Results: Among 4,192 emergency procedures, 106 patients (2.5%) were nonagenarians. Mean age was 92.8 ± 2.6 years, and 74.4% were female. Most patients (95.2%) had ≥ 2 pre-operative comorbidities; the mean Charlson comorbidity index (CCI) was 6.5 ± 1.6. Post-operative complications occurred in 83% of patients. In-hospital mortality was 6.5%, increasing to 9.3% at 30 days and 33.9% at 6 months. Higher CCI, presence of ≥ 2 comorbidities, non-orthopedic surgery, and general anesthesia were associated with increased 6-month mortality. Conclusions: Emergency surgery in nonagenarians was associated with high morbidity and substantial 6-month mortality. Long-term survival appeared more closely related to baseline comorbidity burden and frailty than to immediate surgical factors.

Keywords: Nonagenarian. Emergency surgery. Morbidity. Mortality. Treatment outcome.