A STUDY OF ABDOMINAL SURGICAL EMERGENCIES IN GERIATRIC PATIENTS

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A STUDY OF ABDOMINAL SURGICAL EMERGENCIES IN GERIATRIC PATIENTS

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 24

Abstract

BACKGROUND Emergency surgery is defined as non-elective surgery that is performed with the aim to prevent morbidity or fatal health consequences of a surgically treatable disease.1,2 Aims and Objectives-  To study and analyse the abdominal surgical emergencies in geriatric patients.  To assess the types of abdominal surgical emergencies that occur in geriatric age group of 60 and above.  To assess the type of surgical intervention done.  To study the complications faced in this group undergoing surgical intervention. MATERIALS AND METHODS In this observational study, 113 patients were admitted from Dec. 2015 to May 2017 undergoing surgical intervention within 12 hours. Already diagnosed, conserved and post-operative cases referred to our hospitals were excluded. RESULTS 82% of the patients were from age group 60 - 70 years, where 64 were male and 36 were female patients in the study. There is a significant association between sex and comorbidities (p= 0.001), where 19% of males and 12% of females have hypertension followed by 18% of males and 9% of females having diabetes mellitus, suggesting male patients having more chances of having comorbidities. The proportion of patients having hypertension and diabetes is significantly higher than other comorbidities, i.e. 31% cases suffered from hypertension followed by 27% cases suffering from diabetes mellitus. By applying Z-test of difference between two proportions, the proportion of comorbidities of hypertension and diabetes is significantly higher than other comorbidities (p < 0.01), i.e. 31% cases suffered from hypertension followed by 27% cases suffering from diabetes mellitus. The most common symptom in the study population was Pain (71%). Others were Vomiting (15%), Constipation (7%), Melena (2%) and Fever (5%). By applying Z-test of difference between two proportions, the proportion of symptom of pain and vomiting is significantly higher, i.e. 71% cases and 15% cases respectively (p < 0.01). Many (69%) of the cases had sign of tenderness followed by 19% of the patients having absent peristalsis. By applying Z-test of difference between two proportions, the proportion of tenderness is significantly higher (p < 0.01). X-ray abdomen erect was done in 52% of the cases. In majority (52%) cases, ultrasonography of abdomen and pelvis was done. Closure of perforation (26%) was the most common procedure done followed by Adhesiolysis (17%) and Resection and Anastomosis (10%). In rest of the patients, other procedures were performed. Open Appendicectomy (18%), Liver Suturing, Open Cholecystectomy (10%) and Splenectomy (9%). By applying Z-test of difference between two proportions, the proportion of procedure closure of perforation is significantly higher (p < 0.01). In this study, maximum (28%) surgical emergencies were of intestinal perforation followed by intestinal obstruction (25%) and appendicitis (18%). Others were Spleen Injury (9%), Liver Injury (10%) and Cholelithiasis with Cholecystitis (10%). By applying Z-test of difference between two proportions, the proportion of intestinal perforation was significantly higher (p < 0.001) than other surgical emergencies. Sepsis was the most common (39%) complication followed by Suture Line Infection (24%), Respiratory Distress (14%) and Bleeding (3%). 20% of the patients had no complications. By applying Z-test of difference between two proportions, the proportion of post-operative complications of sepsis is significantly higher than other complications, (p < 0.01). 13 patients out of the total 100 in the study had expired. In the study population, 79% cases had deranged albumin, deranged renal function tests were found in 73% of the cases, 60% patients stayed in the hospital for more than 15 days, 76 patients had hyperglycaemia i.e. random blood sugar level more than 180 mg/dL, 76% patients were anaemic i.e. haemoglobin below 11 g/dL. There is a significant association between RFT and post-operative complications (p= 0.042), suggesting patients with deranged RFT had higher rates of post-operative complications. There is a significant association between albumin and post-operative complications (p= 0.02), suggesting patients with deranged serum albumin levels had higher rates of post-operative complications. There is a significant association between electrolyte imbalance and post-operative complications (p= 0.043). Complications were seen commonly in patients with Electrolyte imbalance. There is no any significant association between duration of stay and postoperative complications (p= 0.125), suggesting in our study population duration of stay did not have any effect on post-operative complications. There is no any significant association between haemoglobin levels and post-operative complications (p= 0.197), suggesting in our study population haemoglobin levels did not have any effect on post-operative complications. There is a significant association between RBS and post-operative complications (p= 0.014). The number of patients with post-operative complications were more with increased RBS (> 180 mg/dL). CONCLUSION This study has helped us in providing better clinical, diagnostic and management criteria to reduce mortality among geriatric age group which are usually neglected.

Authors and Affiliations

Neha Suhas Sawant, Bagwan M. B.

Keywords

Abdominal Surgical Emergencies Geriatric Comorbidities Haemoperitoneum Intestinal Perforation Intestinal Obstruction Resection Anastomosis Adhesiolysis.

EP ID EP450573
DOI 10.14260/jemds/2018/651
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