Nutritional risk in elderly patients undergoing emergency surgery

Introduction Malnutrition in elderly subjects can be an additional risk in emergency surgery. Methods We performed a study on patients in Post Surgical Intensive Care of Sant'Andrea Hospital, Sapienza University of Rome, Italy. 56 patients (33M/23F, mean age 85.6 years, BMI 25.39) undergoing emergency surgery were recruited in the period from May 2016 to July 2017. The following variables were recorded: ASA, SOFA score, weight, body mass index, preoperative albumin and lymphocyte count. After 48 hours all patients were subjected to enteral nutrition through nasogastric tube and intravenous insulin infusion to maintain normoglycemia. We recorded: need for mechanical ventilation, surgical site infection, anastomotic leakage, postoperative hemorrhage, multiorgan failure (MOF). Statistical data analysis studied correlation between predictors and outcome of patients; adjustment of predictors and confounders in order to determine the independent predictors of different outcomes considered. Results Patients included in the study were ASA IV. A total of 52 patients were discharged from Intensive Care Unit. Four patients died in the first few days after surgery (2÷16 days). Mean length of stay in ICU was 5,2 ±3,4 days. Univariate analysis showed a correlation between hypoalbuminemia and the onset of MOF (CI95% [0.043, 0.518] p = 0.004); reduction of the lymphocyte count and risk of MOF (OR: 12:26 [0.087, 0.638], p = 0.008). SOFA score showed a significant correlation with occurrence of pneumonia (OR: 1:46 [1.6, 17.2], p = 0.035) and MOF (OR: 1.77 [1:05, 3:37], p = 0.04). Including the 30-day mortality among confounders, albumin and lymphocyte count were the strongest predictors of MOF. Conclusion Our sample was poor but results of our study seem to indicate malnutrition as an independent risk factor for elderly patients undergoing emergency surgery.