Gastric emergencies in older adults: not always the same old story! A tertiary care emergency department observational cohort study

• Published in: BMJ open 2022-01, Vol.12 (1), p.e056981-e056981
• Main Authors: Rosa, Fausto, Covino, Marcello, Fransvea, Pietro, Cozza, Valerio, Quero, Giuseppe, Fiorillo, Claudio, Simeoni, Benedetta, La Greca, Antonio, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Costamagna, Guido, Alfieri, Sergio
• Format: Article
• Language: English
• Subjects: adult gastroenterology; adult surgery; Age; Aged; Aged, 80 and over; Anticoagulants; Chronic obstructive pulmonary disease; Clinical outcomes; Cohort analysis; Cohort Studies; Comorbidity; Dementia; Emergencies; Emergency Service, Hospital; Endoscopy; Fistula; Gastroenterology and Hepatology; Heart failure; Hospitals; Humans; Hypertension; Intensive care; Kidney diseases; Length of Stay; Observational studies; Older people; Patients; Population; Retrospective Studies; Sepsis; Surgery; Tertiary Healthcare; Ulcers; Variables; Ventilators
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-056981

ObjectiveTo analyse and compare the clinical outcomes between patients ≥80 years and 65–79 years, who presented to our emergency department (ED) with the two most common gastric emergency (GE) clinical presentation, that is, gastric bleeding and gastric perforation.DesignSingle-centre retrospective cohort study.ParticipantsA total of 1011 patients were enrolled: 421 patients aged ≥80 years were compared with a group of 590 patients aged 65–79 years.Primary and secondary outcome measuresThe primary outcome was to compare the overall mortality. Secondary outcomes included major complications, in-hospital length of stay (LOS) and need for surgical procedures.ResultsPatients ≥80 years with GE had different presentations at ED compared with younger patients: they had higher gastrointestinal bleeding (24.9% vs 16.3%, p=0.001), anemisation (14.5% vs 8.8%, p=0.005) and shock (10.9% vs 5.1%, p=0.001) rates. Median LOS, cumulative major complications and mortality rates were similar among the two groups.Multivariate analysis identified shock, gastric malignancy and gastric fistula as independent predictors for survival.ConclusionsPatients ≥80 years with GE did not have a higher mortality rate and cumulative major complications as compared to younger elderly patients. Invasive treatments were not associated with a different prognosis in this age group.