Emergency surgical admissions in patients aged more than 80 years: a studyover four decades

Background: The proportion of older patients in the community is rising. Th e aim of this study was to determine the trend in emergency surgical admiss ions in patients over 80 years of age in 1997 compared with the previous th ree decades. Patients and Methods: Data were obtained on all patients over 80 years of a ge admitted as general surgical emergencies in 1997 to the Royal Berkshire and Battle Hospitals, Reading, UK. Reasons for admission, management, morta lity and duration of hospital stay were recorded and compared with results from 1966, 1976 and 1989. Results: During 1997, 4807 patients over the age of 80 years were admitted as emergencies to all specialities. Of these, 447 (9.3%) were surgical. Thi s compares with 122 in 1966, 248 in 1976 and 339 in 1989. Emergency surgica l workload in patients over 80 years of age had increased from 6.2% in 1966 to 12% in 1997. A random sample of 261 patients was analysed. in-patient m ortality was 13.8% in 1997 compared with 21.8% for 1976 and 22.4% for 1989. Median length of stay was 8 days (range, 0-41 days) for 1997 and 1989 comp ared with 14 days in 1976. Twenty-four patients either needed admission to other specialities or need not have been admitted as emergencies at all and were classified as inappropriate admissions to the general surgical ward. Conclusions: The trend of increased number of patients over the age of 80 y ears being admitted as emergencies to general surgery continues through fou r decades. There has been a decrease in mortality and length of stay since 1966, but no decrease in length of stay in 1997 compared with 1989. Avoidin g inappropriate admissions would result in a significant improvement in bed utilisation for elective surgery and help to reduce waiting lists.