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2015 ; 7
(ä): 55-68
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Emergency surgery in the elderly: challenges and solutions
#MMPMID27147891
Torrance AD
; Powell SL
; Griffiths EA
Open Access Emerg Med
2015[]; 7
(ä): 55-68
PMID27147891
show ga
Elderly patients frequently present with surgical emergencies to health care
providers, and outcomes in this group of patients remain poor. Contributing
factors include frailty, preexisting comorbidity, polypharmacy, delayed
diagnosis, and lack of timely and consultant-led treatment. In this review, we
address common emergency surgical presentations in the elderly and highlight the
specific challenges in caring for these patients. We summarize 20 years of
reports by various medical bodies that have aimed to improve the care of these
patients. To improve morbidity and mortality, several aspects of care need to be
addressed. These include accurate and timely preoperative assessment to identify
treatable pathology and, where possible, to consider and correct age-specific
disease processes. Identification of patients in whom treatment would be futile
or associated with high risk is needed to avoid unnecessary interventions and to
give patients and carers realistic expectations. The use of multidisciplinary
teams to identify common postoperative complications and age-specific syndromes
is paramount. Prevention of complications is preferable to rescue treatment due
to the high proportion of patients who fail to recover from adverse events. Even
with successful surgical treatment, long-term functional decline and increased
dependency are common. More research into emergency surgery in the elderly is
needed to improve care for this growing group of vulnerable patients.