90 and Facing Emergency Surgery? What You Need to Know About Survival Rates
"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.
Growing Emergency Surgery Burden
The number of elderly patients, especially those aged 80 and older, undergoing emergency surgery is increasing, according to a nine-year study at an emergency medical center in South Korea. A 2025 review reports that elderly patients constitute more than 30% of emergency general surgery cases. It also reports that emergency general surgery carries fivefold higher mortality and triple the complication rates of elective procedures. These patients present specific challenges that require attention to improve morbidity and mortality.
Tailored Care With Limited Evidence
Evidence-based principles and expert recommendations emphasize effective preoperative and postoperative care for older adults undergoing emergency surgery. Emergency general surgery in geriatric patients requires a tailored approach to improve outcomes and avoid unnecessary care. However, evidence for perioperative care of older adults remains limited, and guidelines generally perform better for elective than emergency surgery. The Elder-Friendly Approaches to the Surgical Environment model was developed and assessed in a nonrandomized controlled trial involving patients aged 65 years or older undergoing emergency surgery.
Building the Evidence Base
The American College of Surgeons History and Archives Committee created an educational resource to introduce medical students and residents to important milestones that have shaped surgery. Research specifically focused on elderly patients undergoing emergency surgery has historically been limited. A retrospective study reported that increasing age, a worsening American Society of Anesthesiologists score, and plasma albumin below 30 g/litre were associated with worse postoperative outcomes in elderly patients. The study also noted limitations in using these factors to predict outcomes.
What the Research Revealed About Emergency Surgery Survival
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.
- 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.
Research in Patients Over 90
An Italian multicenter retrospective study examined abdominal emergency surgery in patients over 90 years old. The study was authored by Tarasconi, Catena, Abongwa, De Simone, Coccolini, Ansaloni, Roveran, Agresta, Mele, Di Saverio, Vettoretto, Collura, Baiocchi, Portolani, Sartelli, Heyer, and Biondi. It was published in 2016 in the Journal of Peritoneum and Other Serosal Surfaces. Its title directly addresses whether abdominal emergency surgery is worthwhile in this age group.
Emergency Care Versus Elective Evidence
An aging population and advances in surgery have increased the need for geriatric management in emergency general surgical care. Evidence suggests that integrating a proactive geriatric service may improve traditionally measured hospital and patient-based outcomes. However, existing evidence-based perioperative guidelines perform better for elective surgery than for emergency surgery. As a result, decisions for older adults undergoing emergency surgery may be challenging and may rely on clinicians' subjective experience.
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.
Value of Geriatric Comanagement
The role of a geriatrician in emergency surgery for an older adult may vary according to the acuity of the presentation. The cited 2022 guidance strongly recommends perioperative consultation and comanagement. These measures are intended to optimize care delivery and patient outcomes. The recommendation reflects the need to incorporate geriatric expertise into emergency surgical care when appropriate.
Recovery Beyond the Operation
Even when emergency surgery is successful, long-term functional decline and increased dependency are common among elderly patients. Reviews of emergency surgery in the elderly describe specific challenges in caring for this vulnerable group. One review summarizes 20 years of reports from medical bodies that sought to improve care. Both sources emphasize the need for more research and for multiple improvements to reduce morbidity and mortality.