As well, an arterial

blood gas is not typically part of the pre-operative work-up. The APACHE II is a score that is applied within the first 24 hours to a critically ill patient; therefore, it also does #check details randurls[1|1|,|CHEM1|]# not take into account the physiological insults and complications that an elderly patient may experience at a later time. By contrast the ASA classification, initially described by Saklad et al. 1941, can be quickly determined on admission [22]. It has been shown to be predictive of complications and mortality in a global surgical cohort [23]. Our study reinforces that higher ASA class is associated with mortality following emergency general surgery in the elderly. While anesthesia providers often use this score our study demonstrates the value for surgeons using the ASA classification for preoperative risk stratification and discussions. There may be reluctance by physicians to refer patients for surgical treatment due to advanced

age and medical co-morbidities. However, our findings show there was no clear relationship between chronologic age or number of comorbidities with postoperative Hormones inhibitor outcome (morbidity or mortality) after multivariable adjustment. Therefore, age or comorbidities alone should not be the limiting factors for surgical referral or treatment. For most of these surgically treated illnesses, withholding operative care will result in death. Our results indicate markedly higher mortality with rising ASA class. Specifically patients with ASA 4 (severe systemic disease that is a constant threat to life) had the highest risk of death at 33%. Which means surgeons can use this information preoperatively to give estimates of death and morbidity to patients and families. Our analysis suggests that chronological age alone in the cohort of patients aged 80 and above is not a robust measure of outcome. This could be due to a lack of statistical power. However, it Arachidonate 15-lipoxygenase may also be that chronological age is not a major predictor of mortality once more important predictors, such as baseline physical health

(ASA class), is accounted for. Or potentially there may even be a ceiling effect of age wherein age alone does not affect morality in the very elderly population. Although it is always desirable to prevent complications, it is impossible to perform surgery that is complication free. Surgical complications in this group involve a complex interrelationship between baseline vulnerability and precipitating insults occurring during hospitalization [16]. Emergency abdominal surgery is accompanied by many such insults that place elders at particularly high risk for post-operative complications including fasting for gastrointestinal healing, addition of multiple drugs, immobility, nasogastric tubes, and bladder catheterization. Many of these are modifiable and attention to these risk factors should be assessed to prevent post-operative complications in this frail population.