Massachusetts Chapter of the American College of Surgeons

Back to 2022 Program


Open Abdomen in Elderly Patients with Surgical Sepsis: Predictors of Mortality
Jefferson A. Proaño-Zamudio, MD, Dias Argandykov, MD, Wardah Rafaqat, MBBS, Angela Renne, BS, Charudutt N. Paranjape, MD, Stephanie J. Maroney, MD, Haytham M. A. Kaafarani, MD, MPH, David R. King, MD, George C. Velmahos, MD, PhD, John O. Hwabejire, MD, MPH.
Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA

Background: Elderly patients are frequently presenting with emergency surgical conditions. The open abdomen technique is widely used in abdominal emergencies needing rapid control of intrabdominal contamination. However, specific predictors of mortality identifying candidates for comfort care are understudied.
Methods: The 2013-2017 ACS-NSQIP database was queried for emergent laparotomies performed in geriatric patients with sepsis or septic shock in whom fascial closure was delayed. Patients with acute mesenteric ischemia were excluded. The primary outcome was 30-day mortality. Univariable analysis, followed by multivariable logistic regression, was performed.
Results: A total of 1399 patients were identified. The median age was 73(69-79) years, and 54.7% were female. 30-day mortality was 50.6%. In the multivariable analysis, the most important predictors were: dialysis dependence(Odds-ratio[OR]=2.65, 95%CI 1.54–4.57, p < 0.001), CHF (OR=2.53, 95%CI 1.52–4.21, p <0.001), disseminated cancer (OR=2.61, 95%CI 1.55–4.38, p <0.001) and pre-operative thrombocytopenia (OR=1.87, 95%CI 1.15–3.04, p=0.011). The presence of two or more of these factors resulted in over 80% mortality. The absence of all these risk factors results in a survival rate of 62.1%.
Conclusion: In elderly patients, surgical sepsis or septic shock requiring an open abdomen for surgical management is highly lethal. The presence of several combinations of pre-operative comorbidities is associated with a poor prognosis and can identify patients who can benefit from timely initiation of palliative care.


Back to 2022 Program