Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery

INTRODUCTION: With the increasing aging population demographics and life expectancies the number of very elderly patients (age ≥ 80) undergoing emergency surgery is expected to rise. This investigation examines the outcomes in very elderly patients undergoing emergency general surgery, including predictors of in-hospital mortality and morbidity. METHODS: A retrospective study of patients aged 80 and above undergoing emergency surgery between 2008 and 2010 at a tertiary care facility in Canada was conducted. Demographics, comorbidities, surgical indications, and perioperative risk assessment data were collected. Outcomes included length of hospitalization, discharge destination, and in-hospital mortality and morbidity. Multivariable logistic regression was used to identify predictors of in-hospital mortality and complications. RESULTS: Of the 170 patient admissions, the mean age was 84 years and the in-hospital mortality rate was 14.7%. Comorbidities were present in 91% of this older patient population. Over 60% of the patients required further services or alternate level of care on discharge. American Society of Anesthesiologist Physical Status (ASA) Classification (OR 5.30, 95% CI 1.774-15.817, p = 0.003) and the development of an in-hospital complications (OR 2.51, 95% CI 1.210-5.187, p = 0.013) were independent predictors of postoperative mortality. Chronological age or number of comorbidities was not predictive of surgical outcome. CONCLUSIONS: Mortality, complication rates and post-discharge care requirements were high in very elderly patients undergoing emergency general surgery. Advanced age and medical comorbidities alone should not be the limiting factors for surgical referral or treatment. This study illustrates the importance of preventing an in-hospital complication in this very vulnerable population. ASA class is a robust tool which is predictive of mortality in the very elderly population and can be used to guide patient and family counseling in the emergency setting

A Review on All Terrain Vehicle Safety

All-terrain vehicles (ATVs) have become increasing popular in many countries around the world, both for occupational use, as well as recreational use. With an increase in popularity, and the supply of heavier and more powerful machines on the market, major traumas and deaths from ATV use are growing concerns for public health and injury prevention professionals. This review of the literature on ATVs will focus on the mechanism and patterns of ATV-related injuries, the challenges of injury prevention, and the effects of legislation and regulations regarding ATV usage. The increasing burden of injuries and the substantial economic cost from ATV-related traumas and deaths calls for intensification of injury prevention efforts. Modification of risk factors, institution of regulations and legislation, and enforcement of those rules are important steps for prevention of ATV-related harm

The impact of body position on intra-abdominal pressure measurement: a multicenter analysis

Objective: Elevated intra-abdominal pressure (IAP) is a frequent cause of morbidity and mortality among the critically ill. IAP is most commonly measured using the intravesicular or "bladder" technique. The impact of changes in body position on the accuracy of IAP measurements, such as head of bed elevation to reduce the risk of ventilator-associated pneumonia, remains unclear. Design: Prospective, cohort study. Setting: Twelve international intensive care units. Patients: One hundred thirty-two critically ill medical and surgical patients at risk for intra-abdominal hypertension and abdominal compartment syndrome. Interventions: Triplicate intravesicular pressure measurements were performed at least 4 hours apart with the patient in the supine, 15 degrees, and 30 degrees head of bed elevated positions. The zero reference point was the mid-axillary line at the iliac crest. Measurements and Main Results. Mean IAP values at each head of bed position were significantly different (p < 0.0001). The bias between IAP(supine) and IAP(15)degrees was 1.5 mm Hg (1.3-1.7). The bias between IAP(supine) and IAP(30)degrees was 3.7 mm Hg (3.4-4.0). Conclusions: Head of bed elevation results in clinically significant increases in measured IAP. Consistent body positioning from one IAP measurement to the next is necessary to allow consistent trending of IAP for accurate clinical decision making. Studies that involve IAP measurements should describe the patient's body position so that these values may be properly interpreted