CHALLENGES AND MODERN METHODS IN THE MANAGEMENT OF ABDOMINAL SURGICAL EMERGENCIES IN ELDERLY PATIENTS

Abstract

Introduction. This retrospective study aimed to evaluate acute abdominal surgical emergencies in elderly patients and analyze the impact of frailty and comorbidities on prognosis.

Material and Methods. The study included a total of 691 elderly patients admitted and treated at the Municipal Clinical Hospital “St. Archangel Michael”, Chisinau, between 2014 and 2024. Patients were assessed through clinical and paraclinical examinations (X-ray, ultrasound, CT scan, and abdominal Doppler), according to institutional protocols.

Results. The patients’ ages ranged from 65 to 91 years (mean 74.25 ± 7.32 years), including 305 (44.1%) men and 386 (55.9%) women. The most frequent diagnoses were acute cholecystitis – 249 cases (36.1%), acute pancreatitis – 213 (30.8%), acute appendicitis – 87 (12.6%), acute diverticulitis – 18 (2.6%), and intestinal obstruction – 124 (17.9%), which was caused by complicated colonic cancer – 59 (8.5%), volvulus – 16 (2.3%), and adhesive disease – 49 (7.1%). Surgical intervention was required in 435 cases (62.9%). Most patients had an ASA score > 2 (84.9%) and a mean APACHE II score of 19.4 ± 4.9. The overall mortality rate was 23.4%, while the morbidity rate was 76.6%.

Conclusions. Frailty and comorbidities significantly affect prognosis in elderly patients with acute abdominal surgical emergencies, highlighting the need for a multidisciplinary and personalized management approach.