What's the Rush? Challenging the Early Surgery Paradigm for Older Adults in Emergency General Surgery.

Abstract

Rising patient volumes and an aging population are leading to difficulties in providing timely surgical intervention in emergency general surgery (EGS). With decreased resilience and greater comorbidity burden, we hypothesized that older adults would be disproportionately affected by longer preoperative wait times than younger adults. This retrospective cohort study compared older (65 years and older) to younger adults (16 to 64 years) who were urgently/emergently admitted between 2016 and 2020 to undergo 1 of the 7 most common EGS operations using the Virginia Health Information Patient Level Database. Propensity score matching (1:1 nearest neighbor) analyzed the association between delayed time from admission to operation (2 days or more) and the outcomes of postoperative length of stay (POLOS), readmission, inpatient mortality, and total hospital charges, stratifying by older vs younger adults. Controls included demographics, insurance, socioeconomic status, comorbidities, and operative approach. Effect sizes were reported as average treatment effects (ATEs) with 95% CIs. Among 40,502 patients, 14,779 (36.5%) were aged 65 years and older. Delayed surgery occurred in 43.3% of older and 29.8% of younger adults. After matching, delayed surgery in younger adults was associated with increased readmission (ATE 3.5% [2.1% to 4.9%]) and longer POLOS (ATE 0.26 days [0.05 to 0.47]). Conversely, delayed surgery in older adults was not associated with readmission (ATE -0.1% [-1.7% to 1.4%]) and linked to shorter POLOS (ATE -0.45 days [-0.70 to -0.21]). Both age groups experienced similar increases in hospital charges (ATE ≈ $13,500), and mortality was not associated with surgical timing. Contrary to our hypothesis, delayed surgery was associated with worse outcomes in younger, but not older, adults. These findings challenge the prevailing urgency paradigm in EGS and suggest that preoperative optimization may mitigate risks in older adults.