Emergency Colon Resection in the Geriatric Population: the Modified Frailty Index as a Risk Factor of Early Mortality

BACKGROUND

Surgical interventions in the elderly are becoming more frequent given the aging of the population. Due to their increased vulnerability in an emergent context, we aimed to evaluate various risk factors associated with an early mortality and an unfavorable postoperative trajectory.

METHODS

We performed a retrospective, single-center cohort study including patients over the age of 75 who underwent emergency colon resection between January 2016 and December 2020.

RESULTS

Among 299 patients included, the type of resection most frequently encountered was right hemicolectomy (34%). Large bowel obstruction was the surgical indication for 61% of patients (n = 182). The mortality rate within 30 days of primary surgery was 14% (n = 42). The main factors having a significant impact on early mortality were the modified Frailty Index (mFI) (26% vs 4%; p < 0.001), Charlson comorbidity index (CCI) (20 vs 0%; p = 0.03) and surgical indication (36% vs 11%; p = 0.03). No statistically significant difference was observed according to the age of the patients. Patients with a higher mFI ([Formula: see text] 3) had an increased risk of early mortality with an odds ratio (OR) of 11.94 (95%CI: 2.38-59.88; p < 0.001) in multivariate analysis. This association was also observed for the secondary outcomes, as patients with a higher mFI were less likely to return home (59% vs 32%; p = 0.009) and have their stoma closured at the end of the follow-up period (94% vs 33%; p < 0.001).

CONCLUSION

In the geriatric population, the use of mFI is a good predictor of early mortality following an emergency colon resection. This accessible tool could be used to guide the surgical decision-making.

Diverticulitis of the appendix-case report and literature review

Appendiceal diverticulitis is a rare diagnostic most often mistaken for an acute appendicitis. A 72-year-old man presented with a transfixing abdominal pain for 48 hours. Appendicitis was diagnosed on computed tomography scan, but a neoplasm could not be excluded. A laparoscopic hemicolectomy was performed after a surgical consensus considering the neoplastic appearance of the lesion and anatomical feature. Histopathology finally revealed an appendiceal diverticulitis. Appendiceal diverticulum is a rare condition. Most will lead to an appendiceal diverticulitis, which present similarly to an appendicitis. Perforation rate and mortality rate are much higher in appendiceal diverticulitis than in appendicitis. Furthermore, appendiceal diverticular disease is strongly associated with neoplasms, especially mucinous neoplasms and thus pseudomyxoma peritonei. Considering the high complication rate and malignant association, an appendicectomy in case of an appendiceal diverticulitis or of an incidental finding of appendiceal diverticulosis should be recommended to the patient.