Long-term survival in high-risk older adults following emergency general surgery admission

Background — Emergency general surgery (EGS) conditions are increasingly common among nursing home residents. While such patients have a high risk of in-hospital mortality, long-term outcomes in this group are not well described, which may have implications for goals of care discussions. In this study, we evaluate long-term survival among nursing home residents admitted for EGS conditions.

Methods — We performed a population-based, retrospective cohort study of nursing home residents (age = 65) admitted for 1 of 8 EGS diagnoses (appendicitis, cholecystitis, strangulated hernia, bowel obstruction, diverticulitis, peptic ulcer disease, intestinal ischemia, or perforated viscus) from 2006-2018 in a large regional health system. The primary outcome was 1-year survival. To ascertain the effect of EGS admission independent of baseline characteristics, patients were matched to nursing home residents without an EGS admission based on demographics and baseline health. Kaplan-Meier analysis was used to evaluate survival across groups.

Results — 7,942 nursing home residents (mean age 85 years) were admitted with an EGS diagnosis and matched to controls. One quarter of patients underwent surgery and 18% died in hospital. At 1 year, 55% of cases were alive, compared to 72% of controls (p < 0.001). Among those undergoing surgery, 61% were alive at 1 year, compared to 72% of controls (p < 0.001). The 1-year survival probability was 57% in patients who did not require mechanical ventilation, 43% in those who required 1-2 days of ventilation, and 30% in those who required =3 days of ventilation.

Conclusions — Although their risk of in-hospital mortality is high, most nursing home residents admitted for an EGS diagnosis survive at least one year. While nursing home residents presenting with an EGS diagnosis should be cited realistic odds for the risk of death, long-term survival is achievable in the majority of these patients.