Elderly patient surrounded by medical symbols, representing healthcare decisions.

90 and Facing Emergency Surgery? What You Need to Know About Survival Rates

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"A groundbreaking Italian study sheds light on the outcomes of emergency abdominal surgery in nonagenarians, challenging assumptions and offering crucial insights for families and healthcare providers."

As life expectancy increases, more individuals are living well into their 90s. This demographic shift brings new challenges to emergency medicine, particularly when older adults require urgent surgical interventions. Unlike elective surgeries, which allow for careful planning and risk mitigation, emergency procedures often involve immediate, life-threatening situations that demand swift action.

Emergency abdominal surgery in nonagenarians (people aged 90 and older) is a complex field with limited research. While there's extensive data on cardiac and other elective surgeries in the elderly, information on emergency abdominal procedures in this age group remains scarce. Available data suggests that about 50% of patients survive one year post-operation, highlighting the critical need for more comprehensive studies.

To address this gap, an Italian multicenter retrospective study was conducted to determine the two-year survival rate after emergency abdominal surgery in nonagenarians. The study also aimed to identify any demographic or surgical parameters that could predict poor outcomes, providing valuable insights for healthcare providers and families facing these difficult decisions.

What the Research Revealed About Emergency Surgery Survival

Elderly patient surrounded by medical symbols, representing healthcare decisions.

The study, a retrospective multicenter trial, included patients aged 90 years or older who underwent urgent abdominal surgery. Data was collected from six Italian hospitals, focusing on various factors, including gender, age, ASA (American Society of Anesthesiologists) score, comorbidities, diagnosis, time to surgery, surgical procedures, anesthesia type, and hospital length of stay. Survival rates were assessed through phone call follow-ups, and Kaplan-Meier analysis was used to evaluate survival.

The research identified 72 nonagenarian patients (20 males and 52 females) who underwent emergency abdominal surgery. The average age was 92.5 years, with an ASA score of 3.32, indicating significant pre-existing health issues. Key findings include:

High Mortality Rate: The in-hospital mortality rate was 23%, indicating a significant risk associated with emergency abdominal surgery in this age group.
Low Two-Year Survival Rate: The two-year survival rate was only 23%, underscoring the long-term challenges faced by these patients. The mean follow-up time was 10 months (ranging from 1-27 months).
ASA Score as a Predictor: Among all the parameters analyzed, only the ASA score was significantly correlated with survival. This suggests that the overall health status and pre-existing conditions play a crucial role in determining outcomes.
Comorbidities and Malignancy: The presence of malignancy or the absence of comorbidities did not significantly correlate with survival, challenging some common assumptions about risk factors.

These findings suggest that nonagenarian patients undergoing emergent abdominal surgical procedures face a high risk of in-hospital mortality and a low two-year survival rate. The ASA score is a critical factor in predicting outcomes, but other factors do not appear to significantly influence survival rates. This underscores the need for careful evaluation and realistic expectations when considering emergency abdominal surgery in frail, elderly patients.

Making Informed Decisions for Elderly Patients

The study highlights the importance of carefully evaluating the risks and benefits of emergency abdominal surgery in patients over 90. Given the high mortality rate and low two-year survival rate, healthcare providers and families must have realistic expectations and consider the patient's overall health status when making treatment decisions. While emergency surgery can be life-saving, it is essential to weigh the potential outcomes and quality of life for these frail patients.

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This article is based on research published under:

DOI-LINK: 10.4081/joper.2016.1, Alternate LINK

Title: Abdominal Emergency Surgery In Patients Over 90 Years Old: Is It Worthwhile? An Italian Multicenter Retrospective Study

Subject: Cell Biology

Journal: Journal of Peritoneum (and other serosal surfaces)

Publisher: PAGEPress Publications

Authors: Antonio Tarasconi, Fausto Catena, Hariscine K. Abongwa, Belinda De Simone, Federico Coccolini, Luca Ansaloni, Antonietta Roveran, Ferdinando Agresta, Marcella Mele, Salomone Di Saverio, Nereo Vettoretto, Simone Collura, Gianluca Baiocchi, Nazario Portolani, Massimo Sartelli, Arianna Heyer, Antonio Biondi

Published: 2016-07-04

Everything You Need To Know

What is the in-hospital mortality rate for nonagenarians undergoing emergency abdominal surgery?

The in-hospital mortality rate was 23%, indicating a significant risk associated with emergency abdominal surgery for nonagenarians. This means that of the patients who underwent the procedure, nearly a quarter did not survive the hospital stay. This is a crucial piece of information because it emphasizes the immediate danger involved in this type of surgery for individuals aged 90 and older. It highlights the immediate risk and the urgency of making informed decisions.

What are the long-term survival rates following emergency abdominal surgery for patients over 90?

The two-year survival rate was only 23%. This signifies that out of the nonagenarian patients who survived the initial surgery and hospital stay, only about a quarter were still alive two years later. The mean follow-up time was 10 months, ranging from 1-27 months. This low survival rate underscores the long-term challenges faced by these patients. This is important because it illustrates the overall poor prognosis for this demographic and emphasizes the need for a comprehensive understanding of the situation.

What factors were found to be predictors of survival in this study?

The American Society of Anesthesiologists (ASA) score was significantly correlated with survival. This suggests that the overall health status and pre-existing conditions play a crucial role in determining outcomes. This means that patients with higher ASA scores, indicating more severe pre-existing health issues, were less likely to survive. The ASA score, which assesses the patient's overall health, is a key predictor in this context. This is very significant because it provides a quantifiable measure to assess a patient's risk and aids in decision-making.

What did the study reveal about the impact of specific conditions, like cancer, on survival rates?

The study found that the presence of malignancy or the absence of comorbidities did not significantly correlate with survival, challenging some common assumptions about risk factors. This means that while these factors might seem like predictors of survival, in this specific study, they did not have a statistically significant impact on whether a patient lived or died. This is important because it suggests that the focus should be more on the ASA score and overall health status rather than on specific conditions like cancer or the number of pre-existing health problems. It challenges established beliefs about risk.

What are the key considerations for making decisions about emergency abdominal surgery for elderly patients?

When considering emergency abdominal surgery for nonagenarians, healthcare providers and families must have realistic expectations and consider the patient's overall health status when making treatment decisions. Given the high mortality rate and low two-year survival rate, it is essential to weigh the potential outcomes and quality of life for these frail patients. While emergency surgery can be life-saving, it is crucial to assess the patient's ASA score and pre-existing conditions, as these play a significant role in their survival. The implications include the need for careful evaluation of risks and benefits and an honest discussion of the patient's potential quality of life post-surgery.