APEROLD study: acute peritonitis in the oldest nonagenarian patients with acute abdomen. Which is the fate?

Vol. 2 No. 1 (2025)
Submitted: May 30, 2024
Accepted: January 16, 2025
Published: February 17, 2025
Frailty, emergency surgery, geriatric patient, peritonitis
Abstract Views: 17
PDF: 18
SUPPLEMENTARY MATERIAL: 2
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Raffaele Bova
https://orcid.org/0000-0002-1720-0792
General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
Giulia Griggio
General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
Carlo Vallicelli
Carlo.vallicelli@auslromagna.it
General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
Luca Ansaloni
Department of General and Emergency Surgery, Policlinico San Matteo, Pavia, Italy.
Massimo Sartelli
https://orcid.org/0000-0003-3202-7542
Department of Surgery, Macerata Hospital, Italy.
Federico Coccolini
General, Emergency and Trauma Surgery Department, Pisa University Hospital, Italy.
Francesca Bravi
Healthcare Administration, Santa Maria delle Croci Hospital, Ravenna, Italy.
Vanni Agnoletti
Anesthesia, Intensive Care and Trauma Department, Bufalini Hospital, Cesena, Italy.
Fausto Catena
General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.

This is a prospective, multicenter, observational study whose objective is to investigate the impact of emergency abdominal surgery versus nonoperative therapy on the outcomes of nonagenarians. All consecutive patients aged 90 years or older admitted to the surgical department for acute secondary peritonitis and undergoing urgent or emergency surgery or nonoperative management will be invited to participate. They can choose to consent or decline for a 30-day data collection period. The primary aim of this study is to evaluate early and late outcomes: 30-day and 1-year survival rates, clinical course and postoperative complications rate, and 1-year functional status. The secondary aim is to investigate which factors contribute to the choice of surgical intervention over nonoperative management, as well as the accuracy of risk scoring systems in predicting poor outcomes or functional loss: P-POSSUM score, American Society of Anesthesiologists (ASA) score, APACHE II score, Charlson's Comorbidity Index (CCI), Flemish version of the Triage Risk Screening Tool (fTRST), and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator. According to our experience, the time is ripe for large multicenter trials to establish an ultimate scoring system for statistical probability of survival or treatment success, with the ultimate goal of obtaining evidence to guide the management of the emergency in people older than 90 years.

Dimensions

Altmetric

PlumX Metrics

Downloads

Citations

1. GBD US Health Disparities Collaborators. Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. Lancet 2022.
2. Kennedy CA, Shipway D, Barry K. Frailty and emergency abdominal surgery: A systematic review and meta-analysis. Surgeon 2022.
3. Karamercan MA, Dündar DZ, Slagman A, et al. Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study [published correction appears in Eur J Emerg Med 2023;30:224]. Eur J Emerg Med 2023;30:117-24.
4. Portinari M, Bianchi L, De Troia A, et al. Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study. Eur J Trauma Emerg Surg 2022;48:1205-16.
5. Ellis G, Marshall T, Ritchie C. Comprehensive geriatric assessment in the emergency department. Clin Interv Aging 2014;9:2033-43.
6. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 2006;203:865-77.
7. Racz J, Dubois L, Katchky A, Wall W. Elective and emergency abdominal surgery in patients 90 years of age or older. Can J Surg 2012;55:322-8.
8. NELA Project Team. Seventh Patient Report of the National Emergency Laparotomy Audit RCoA London 2021.
9. Søreide K, Desserud KF. Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scand J Trauma Resusc Emerg Med 2015;23:10.
10. 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.
11. Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg 2021;16:49.
12. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-56.
13. Trotter G. Mediating disputes about medical futility. Camb Q Healthc Ethics 1999;8:527-37.
14. Javanmard-Emamghissi H, Moug SJ. The virtual uncertainty of futility in emergency surgery. Br J Surg 2022;109:1184–5.
15. Statement on ASA Physical Status Classification System, Developed By: Committee on Economics. Last Amended: December 13, 2020 (original approval: October 15, 2014). Available from: https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system
16. Kenis C, Decoster L, Van Puyvelde K, et al. Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 2014;32:19-26.
17. Okazaki H, Shirakabe A, Hata N, et al. New scoring system (APACHE-HF) for predicting adverse outcomes in patients with acute heart failure: evaluation of the APACHE II and Modified APACHE II scoring systems. J Cardiol 2014;64:441-9.
18. Aggarwal A, Chittoria RK, Chavan VK, et al. The role of comorbidities in the prognosis of thermal burns. Indian J Burns 2019;27:16-9.
19. Banu P, Popa F, Constantin VD, Balalau C. Predictive value of POSSUM score in surgery of acute abdomen in cirrhotic patients. J Med Life 2013;6:472-6.
20. Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217:833-42.e423.
21. Oliver CM, Walker E, Giannaris S, et al. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. Br J Anaesth 2015;115:849-60.
22. Pelavski AD, Lacasta A, Rochera MI, et al. Observational study of nonagenarians undergoing emergency, non-trauma surgery. Br J Anaesth 2011;106:189-93.
23. Perregaard H, Tenma J, Antonsen J, Mynster T. Mortality after abdominal emergency surgery in nonagenarians. Eur J Trauma Emerg Surg 2021;47.

How to Cite

Bova, R., Griggio, G., Vallicelli, C., Ansaloni, L., Sartelli, M., Coccolini, F., … Catena, F. (2025). APEROLD study: acute peritonitis in the oldest nonagenarian patients with acute abdomen. Which is the fate?. Surgery in Geriatrics and Frailty, 2(1). Retrieved from https://www.sigaf.eu/site/article/view/13
Copyright (c) 2025 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.