Common themes in geriatric emergency general surgery: a narrative review

Submitted: January 8, 2024
Accepted: May 21, 2024
Published: June 25, 2024
Abstract Views: 442
PDF: 137
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Population aging is a growing phenomenon. The geriatric patient is defined by physical, psychological, and social characteristics associated with aging that make him or her more fragile and susceptible. An older patient is usually fragile: frailty has a linear, if not unambiguous, relationship with age. With this background, the concept of futility emerges in emergency surgery, which refers to having a goal but being almost certain of failure in achieving it. A narrative review of the literature was carried out using PubMed, Google Scholar, and Cochrane to identify pertinent publications. Inclusion criteria included: i) an emergency setting in geriatric general surgery, ii) frailty in emergency surgery, and iii) futility in emergency surgery. The study identified valid assessment scores for older and frail patients, as well as imaging tools that may aid in the evaluation of frailty, demonstrating the potential futility of surgical treatment. The review addressed the most common acute surgical situations that affect geriatric patients. Older patients are more fragile and vulnerable than the general population, even though geriatric age does not always correlate with frailty. Several fragility scores have been developed to perform an accurate preoperative assessment of the urgent elderly surgical patient, to estimate treatment futility and perioperative risk, and to guide the surgeon to the most appropriate therapeutic or palliative action.

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Kapadia M, Obaid O, Nelson A, et al. Evaluation of frailty assessment compliance in acute care surgery: changing trends, lessons learned. J Surg Res 2022;270:236-44.
Panayi AC, Orkaby AR, Sakthivel D, et al. Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. Am J Surg 2019;218:393-400.
Trotter G. Mediating disputes about medical futility. Camb Q Healthc Ethics 1999;8:527-37.
Javanmard-Emamghissi H, Moug SJ. The virtual uncertainty of futility in emergency surgery. Br J Surg 2022;109:1184–5.
Adelson BH. Resolving ethical dilemmas: a guide for clinicians. JAMA 1995;274:587–88.
Parmar KL, Law J, Carter B, et al. Frailty in older patients undergoing emergency laparotomy: results from the UK observational Emergency Laparotomy and Frailty (ELF) study. Ann Surg 2021;273:709-18.
Law J, Welch C, Javanmard-Emamghissi H, et al. Decision-making for older patients undergoing emergency laparotomy: defining patient and clinician values and priorities. Colorectal Dis 2020;22:1694-703.
Lambden JP, Chamberlin P, Kozlov E, et al. Association of perceived futile or potentially inappropriate care with burnout and thoughts of quitting among health-care providers. Am J Hosp Palliat Care 2019;36:200-6.
Aggarwal G, Scott M, Peden CJ. Emergency laparotomy. Anesthesiol Clin 2022;40:199-211.
Ablett AD, McCarthy K, Carter B. A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multi-center study. Int J Surg 2018;60:236-44.
Ho VP, Bensken WP, Warner DF. Association of complex multimorbidity and long-term survival after emergency general surgery in older patients with medicare. JAMA Surg 2022;157:499-506.
Aucoin S, McIsaac DI. Emergency general surgery in older adults: a review. Anesthesiol Clin 2019;37:493-505.
Pisano M, Ceresoli M, Cimbanassi S, et al. 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 2019;14:10.
Elamin A, Tsoutsanis P, Sinan L. Emergency general surgery: predicting morbidity and mortality in the geriatric population. Surg J (NY) 2022;8:e270-8.
Ahmed SM, Alali MA, Atuel KLG. American Society of Anesthesiologists Physical Status Classification System: history, development, reliability, and its future. In: Sozen S, editor. Surgical Recovery. London: IntechOpen; 2019. Available from: https://www.intechopen.com/chapters/70432 doi: 10.5772/intechopen.89704
Bolger JC, Zaidi A, Fuentes-Bonachera A, Kelly ME. Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting. Geriatr Gerontol Int 2018;18:1211-4.
Vilches-Moraga A, Rowley M, Fox J. Emergency laparotomy in the older patient: factors predictive of 12-month mortality-Salford-POPS-GS. An observational study. Aging Clin Exp Res 2020;32:2367-73.
Sezen Ö, Çevik B. Emergency surgery in geriatrics: A retrospective evaluation in a single center. Ulus Travma Acil Cerrahi Derg 2020;26:411-7.
Hewitt J, Carter B, McCarthy K. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019;48:388-94.
Zattoni D, Montroni I, Saur NM, et al. Prediction of functional loss in emergency surgery is possible with a simple frailty screening tool. World J Emerg Surg 2021;16:12.
Fehlmann CA, Patel D, McCallum J. Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022;48:141-51.
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489-95.
Goeteyn J, Evans LA, De Cleyn S, et al. Frailty as a predictor of mortality in the elderly emergency general surgery patient. Acta Chir Belg 2017;117:370-5.
Eamer GJ, Clement F, Holroyd-Leduc J, et al. Frailty predicts increased costs in emergent general surgery patients: A prospective cohort cost analysis. Surgery 2019;166:82-7.
Cheung A, Haas B, Ringer TJ, et al. Canadian study of health and aging clinical frailty scale: does it predict adverse outcomes among geriatric trauma patients? J Am Coll Surg 2017;225:658-665.e3.
Mintziras I, Miligkos M, Wächter S, et al. Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: Systematic review and meta-analysis. Int J Surg 2018;59:19-26.
Kołodziejska K, Witowski J, Tylec P, et al. Radiological features for frailty assessment in patients requiring emergency laparotomy. J Clin Med 2022;11:5365.
Thu K, Nguyen HPT, Gogulan T, et al. Care of older people in surgery for general surgery: a single centre experience. ANZ J Surg 2021;91:890-5.
Kaplan SJ, Pham TN, Arbabi S, et al. Association of radiologic indicators of frailty with 1-year mortality in older trauma patients: opportunistic screening for sarcopenia and osteopenia. JAMA Surg 2017;152:e164604.
Pędziwiatr M, Pisarska M, Major P, et al. Laparoscopic colorectal cancer surgery combined with enhanced recovery after surgery protocol (ERAS) reduces the negative impact of sarcopenia on short-term outcomes. Eur J Surg Oncol 2016;42:779-87.
Pecorelli N, Capretti G, Sandini M, et al. Impact of sarcopenic obesity on failure to rescue from major complications following pancreaticoduodenectomy for cancer: results from a multicenter study. Ann Surg Oncol 2018;25:308-17.
Ratnayake CBB, Wells C, Olsson M, et al. Sarcopenic obesity and post-operative morbidity after pancreatic surgery: a cohort study. ANZ J Surg 2019;89:1587-92.
Zhang WT, Lin J, Chen WS, et al. Sarcopenic obesity is associated with severe postoperative complications in gastric cancer patients undergoing gastrectomy: a prospective study. J Gastrointest Surg 2018;22:1861-9.
Mason MC, Crees AL, Dean MR, Bashir N. Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study. Int J Clin Pract 2018;72:e13096.
Khan M, Jehan F, Zeeshan M, et al. Failure to rescue after emergency general surgery in geriatric patients: does frailty matter? J Surg Res 2019;233:397-402.
Palaniappan S, Soiza RL, Duffy S, et al. Comparison of the clinical frailty score (CFS) to the National Emergency Laparotomy Audit (NELA) risk calculator in all patients undergoing emergency laparotomy. Colorectal Dis 2022;24:782-9.
Aitken RM, Partridge JSL, Oliver CM, et al. Older patients undergoing emergency laparotomy: observations from the National Emergency Laparotomy Audit (NELA) years 1-4. Age Ageing 2020;49:656-63.
Ho VP, Schiltz NK, Reimer AP, et al. High-risk comorbidity combinations in older patients undergoing emergency general surgery. J Am Geriatr Soc 2019;67:503-10.
Torrance AD, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med 2015;7:55-68.
Zattoni D, Christoforidis D. How best to palliate and treat emergency conditions in geriatric patients with colorectal cancer. Eur J Surg Oncol 2020;46:369-78.
Tan HL, Chia STX, Nadkarni NV, et al. Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study. World J Emerg Surg 2019;14:62.
Murphy PB, Savage SA, Zarzaur BL. Impact of patient frailty on morbidity and mortality after common emergency general surgery operations. J Surg Res 2020;247:95-102.
Becher RD, Murphy TE, Gahbauer EA, et al. Factors associated with functional recovery among older survivors of major surgery. Ann Surg 2020;272:92-8.
Liu X, Le MK, Lim AYC, et al. Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study. BMC Geriatr 2022;22:58.
Kenawy DM, Renshaw SM, George E, et al. Increasing frailty in geriatric emergency general surgery: a cause for concern. J Surg Res 2021;266:320-7.
Zattoni D, Montroni I, Saur NM, et al. A simple screening tool to predict outcomes in older adults undergoing emergency general surgery. J Am Geriatr Soc 2019;67:309-16.
Engelhardt KE, Reuter Q, Liu J, et al. Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients. J Trauma Acute Care Surg 2018;85:167-73.
Mahmooth Z, Carpenter E, Lin E, et al. Frailty assessment in the acute care surgery population - the agreement and predictive value on length of stay and re-admission of 3 different instruments in a prospective cohort. Am J Surg 2020;220:1058-63.
Orouji Jokar T, Ibraheem K, Rhee P, et al. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg 2016;81:254-60.
Weiss HK, Stocker BW, Weingarten N, et al. Electronic medical record versus bedside assessment: how to evaluate frailty in trauma and emergency general surgery patients? J Surg Res 2020;246:464-75.
Boyd-Carson H, Gana T, Lockwood S, et al. A review of surgical and peri-operative factors to consider in emergency laparotomy care. Anaesthesia 2020;75:e75-e82.
Ablett AD, McCarthy K, Carter B, et al. A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multi-center study. Int J Surg 2018;60:236-44.
Festi D, Dormi A, Capodicasa S, et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol 2008;14:5282-9.
Sanson TG, O'Keefe KP. Evaluation of abdominal pain in the elderly. Emerg Med Clin North Am 1996;14:615-27.
Ragsdale L, Southerland L. Acute abdominal pain in the older adult. Emerg Med Clin North Am 2011;29:429-48, x.
Ross SO, Forsmark CE. Pancreatic and biliary disorders in the elderly. Gastroenterol Clin North Am 2001;30:531-45, x.
Lavretsky H, Newhouse PA. Stress, inflammation, and aging. Am J Geriatr Psychiatry 2012;20:729-33.
Parker LJ, Vukov LF, Wollan PC. Emergency department evaluation of geriatric patients with acute cholecystitis. Acad Emerg Med 1997;4:51-5.
McGillicuddy EA, Schuster KM, Brown E, et al. Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography. Am J Surg 2011;202:524-7.
Asiltürk Lülleci Z, Başyiğit S, Pirinççi Sapmaz F, et al. Comparison of ultrasonographic and laboratory findings of acute cholecystitis between elderly and nonelderly patients. Turk J Med Sci 2016;46:1428-33.
Preston SD, Southall AR, Nel M, Das SK. Geriatric surgery is about disease, not age. J R Soc Med 2008;101:409-15.
Riall TS, Zhang D, Townsend CM Jr, et al. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg 2010;210:668-77, 677-9.
Coccolini F, Catena F, Pisano M, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg 2015;18:196-204. Erratum in: Int J Surg 2015;24:107.
Elshaer M, Gravante G, Thomas K, et al. Subtotal cholecystectomy for "difficult gallbladders": systematic review and meta-analysis. JAMA Surg 2015;150:159-68.
Palanivelu C, Rajan PS, Jani K, et al. Laparoscopic cholecystectomy in cirrhotic patients: the role of subtotal cholecystectomy and its variants. J Am Coll Surg 2006;203:145-51.
Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016;11:25.
Bakkaloglu H, Yanar H, Guloglu R, et al. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol 2006;12:7179-82.
Miura F, Takada T, Kawarada Y, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007;14:27-34.
Nasim S, Khan S, Alvi R, Chaudhary M. Emerging indications for percutaneous cholecystostomy for the management of acute cholecystitis--a retrospective review. Int J Surg 2011;9:456-9.
Venara A, Carretier V, Lebigot J, Lermite E. Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014. J Visc Surg 2014;151:435-9.
Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2013;2013:CD003327.
Wang B, Guo Z, Liu Z, et al. Preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones: system review and meta-analysis. Surg Endosc 2013;27:2454-65.
Blomqvist PG, Andersson RE, Granath F, et al. Mortality after appendectomy in Sweden, 1987-1996. Ann Surg 2001;233:455-60.
Massarweh NN, Legner VJ, Symons RG, et al. Impact of advancing age on abdominal surgical outcomes. Arch Surg 2009;144:1108-14.
Lee JF, Leow CK, Lau WY. Appendicitis in the elderly. Aust N Z J Surg 2000;70:593-6.
Yamini D, Vargas H, Bongard F, et al. Perforated appendicitis: is it truly a surgical urgency? Am Surg 1998;64:970-5.
Sanson TG, O'Keefe KP. Evaluation of abdominal pain in the elderly. Emerg Med Clin North Am 1996;14:615-27.
Paranjape C, Dalia S, Pan J, Horattas M. Appendicitis in the elderly: a change in the laparoscopic era. Surg Endosc 2007;21:777-81.
Omari AH, Khammash MR, Qasaimeh GR, et al. Acute appendicitis in the elderly: risk factors for perforation. World J Emerg Surg 2014;9:6.
Tan KY, Chen CM, Ng C, et al. Which octogenarians do poorly after major open abdominal surgery in our Asian population? World J Surg 2006;30:547-52.
Ten Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg 2018;13:24.
Branco BC, Barmparas G, Schnüriger B, et al. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 2010;97:470-8.
Krause WR, Webb TP. Geriatric small bowel obstruction: an analysis of treatment and outcomes compared with a younger cohort. Am J Surg 2015;209:347-51.
Paul CJJ, Dohmen J, van Beekum CJ, et al. Surgical treatment of mechanical bowel obstruction: characteristics and outcomes of geriatric patients compared to a younger cohort. Int J Colorectal Dis 2022;37:1281-8.
van Beekum CJ, Stoffels B, von Websky M, et al. Der mechanische Ileus bei geriatrischen Patienten: Ätiologie und perioperative Morbidität/Mortalität im Vergleich zu einer jüngeren Patientenkohorte Mechanical bowel obstruction in geriatric patients : Etiology and perioperative morbidity/mortality compared with a younger cohort. Med Klin Intensivmed Notfmed 2020;115:22-28. German.
Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am 2008;92:575-97.
Karakaş DÖ, Yeşiltaş M, Gökçek B, et al. Etiology, management, and survival of acute mechanical bowel obstruction: Five-year results of a training and research hospital in Turkey. Ulus Travma Acil Cerrahi Derg 2019;25:268-80.
Santangelo ML, Grifasi C, Criscitiello C, et al. Bowel obstruction and peritoneal carcinomatosis in the elderly. A systematic review. Aging Clin Exp Res 2017;29:73-8.
Bükki J. Re: recommendations for bowel obstruction with peritoneal carcinomatosis by laval et Al. J Pain Symptom Manage 2014;48:e5-6.
Krstic S, Resanovic V, Alempijevic T, et al. Hartmann's procedure vs loop colostomy in the treatment of obstructive rectosigmoid cancer. World J Emerg Surg 2014;9:52.
Crawford RS, Harris DG, Klyushnenkova EN, et al. A statewide analysis of the incidence and outcomes of acute mesenteric ischemia in Maryland from 2009 to 2013. Front Surg 2016;3:22.
Tseng J, Loper B, Jain M, et al. Predictive factors of mortality after colectomy in ischemic colitis: an ACS-NSQIP database study. Trauma Surg Acute Care Open 2017;2:e000126.
Roobottom CA, Dubbins PA. Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography. AJR Am J Roentgenol 1993;161:985-8.
Bekwelem W, Connolly SJ, Halperin JL, et al. Extracranial systemic embolic events in patients with nonvalvular atrial fibrillation: incidence, risk factors, and outcomes. Circulation 2015;132:796-803.
Amitrano L, Brancaccio V, Guardascione MA, et al. High prevalence of thrombophilic genotypes in patients with acute mesenteric vein thrombosis. Am J Gastroenterol 2001;96:146-9.
Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2017;12:38.
Gebran A, Gallastegi AD, Fagenholz P, et al. Factors that predict survival from mesenteric ischemia in the geriatric patient: not a death sentence. Am Surg 2021:31348211050585.
Kleinhenz ME, Lewis CY. Chronic ventilator dependence in elderly patients. Clin Geriatr Med 2000;16:735-56.
Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr 2002;22:309-23.
Viale PH. The American Cancer Society's Facts & Figures: 2020 Edition. J Adv Pract Oncol 2020;11:135-6.
Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer. Surg Clin North Am 2017;97:529-45.
Neuman HB, O'Connor ES, Weiss J, et al. Surgical treatment of colon cancer in patients aged 80 years and older: analysis of 31,574 patients in the SEER-Medicare database. Cancer 2013;119:639-47.
Esteva M, Ruidíaz M, Sánchez MA, et al. Emergency presentation of colorectal patients in Spain. PLoS One 2018;13:e0203556. Erratum in: PLoS One 2018;13:e0207143.
National Bowel Cancer Audit, Annual report. 2018. Available from: https://www.hqip.org.uk/wp-content/uploads/2018/12/ref73_nboca-annual-report-2018_final_20181213 pdf; 2018 Accessed 02/02/2019
Askari A, Nachiappan S, Currie A, et al. Who requires emergency surgery for colorectal cancer and can national screening programmes reduce this need? Int J Surg 2017;42:60-8.
Amri R, Bordeianou LG, Sylla P, Berger DL. Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 2015;209:246-53.
Tekkis PP, Kinsman R, Thompson MR, et al. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 2004;240:76-81.
Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned. J Gastrointest Surg 2011;15:110-9.
Alvarez JA, Baldonedo RF, Bear IG, et al. Obstructing colorectal carcinoma: outcome and risk factors for morbidity and mortality. Dig Surg 2005;2:174-81.
Biondo S, Parés D, Frago R, et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 2004;47:1889-97.
Manceau G, Mege D, Bridoux V, et al. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019;21:782-90.
Honoré C, Goéré D, Souadka A, et al. Definition of patients presenting a high risk of developing peritoneal carcinomatosis after curative surgery for colorectal cancer: a systematic review. Ann Surg Oncol 2013;20:183-92.
Cooper Z, Courtwright A, Karlage A, et al. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg 2014;260:949-57.
Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004;99:2051-7.
Foo CC, Poon SHT, Chiu RHY, et al. Is bridge to surgery stenting a safe alternative to emergency surgery in malignant colonic obstruction: a meta-analysis of randomized control trials. Surg Endosc 2019;33:293-302.
Sabbagh C, Browet F, Diouf M, et al. Is stenting as "a bridge to surgery" an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013;258:107-15.
van Hooft JE, Veld JV, Arnold D, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020;52:389-407.
Ansaloni L, Andersson RE, Bazzoli F, et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg 2010;5:29.
Tarantino I, Warschkow R, Worni M, et al. Prognostic relevance of palliative primary tumor removal in 37,793 metastatic colorectal cancer patients: a population-based, propensity score-adjusted trend analysis. Ann Surg 2015;262:112-20.
de Boer NL, Hagemans JAW, Schultze BTA, et al. Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery. Eur J Surg Oncol 2019;45:389-93.
Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 2008;51:296-300.
Cerdán Santacruz C, Frasson M, Flor-Lorente B, et al. Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study. Surg Endosc 2017;31:5032-42.
Desserud KF, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg 2016;103:e52-61.
Duron JJ, Duron E, Dugue T, et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 2011;254:375-82.
Spanjersberg WR, van Sambeeck JD, Bremers A, et al. Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 2015;29:3443-53.
Lohsiriwat V, Jitmungngan R. Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices. World J Gastrointest Surg 2019;11:41-52.
Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA 2017;318:1161-74.
Berian JR, Mohanty S, Ko CY, et al. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. JAMA Surg 2016;151:e161689.
Holcomb JB, Jenkins D. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007;62:307-10.
Rotondo MF, Schwab CW, McGonigal MD, et al. 'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993;35:375-82; discussion 382-3.
Sohn M, Agha A, Heitland W, et al. Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis. Tech Coloproctol 2016;20:577-83.
Stawicki SP, Brooks A, Bilski T, et al. The concept of damage control: extending the paradigm to emergency general surgery. Injury 2008;39:93-101.
Tartaglia D, Costa G, Camillò A, et al. Damage control surgery for perforated diverticulitis with diffuse peritonitis: saves lives and reduces ostomy. World J Emerg Surg 2019;14:19.
Kafka-Ritsch R, Birkfellner F, Perathoner A, et al. Damage control surgery with abdominal vacuum and delayed bowel reconstruction in patients with perforated diverticulitis Hinchey III/IV. J Gastrointest Surg 2012;16:1915-22.
Iacono SA, Krumrei NJ, Niroomand A, et al. Age is but a number: damage control surgery outcomes in geriatric emergency general surgery. J Surg Res 2021;267:452-7.
McComb A, Warkentin LM, McNeely ML, Khadaroo RG. Development of a reconditioning program for elderly abdominal surgery patients: the Elder-friendly Approaches to the Surgical Environment-BEdside reconditioning for Functional ImprovemenTs (EASE-BE FIT) pilot study. World J Emerg Surg 2018;13:21.
Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. JAMA Intern Med 2019;179:28-36. Erratum in: JAMA Intern Med 2019;179:127.
El-Sharkawy AM, Sahota O, Maughan RJ, Lobo DN. The pathophysiology of fluid and electrolyte balance in the older adult surgical patient. Clin Nutr 2014;33:6-13.
Kaiser MJ, Bauer JM, Rämsch C. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58:1734-8.
Rangel EL, Rios-Diaz AJ, Uyeda JW, et al. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery. J Trauma Acute Care Surg 2017;83:1179-86.
Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017;36:623-50.

How to Cite

Santandrea, G., Vallicelli, C., Carcoforo, P., Agnoletti, V., Bravi, F., & Catena, F. (2024). Common themes in geriatric emergency general surgery: a narrative review. Surgery in Geriatrics and Frailty, 1(1). Retrieved from https://www.sigaf.eu/site/article/view/11