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

Objective: To analyze and compare the clinical outcomes between patients
≥80 years and patients 65-79 years, presented to our Emergency Department
(ED) with the two most common Gastric Emergencies (GE) clinical
presentation, i.e. gastric bleeding and gastric perforation. Design:
Single-center retrospective cohort study. Participants: A total of 1011
patients were enrolled: 421 patients aged ≥80 years were compared to a
group of 590 patients aged 65-79 years. Primary and secondary outcome
measures: The primary outcome was to compare the overall mortality.
Secondary outcomes included major complications, in-hospital length of
stay (LOS), and need for surgical procedures. Results: Patients ≥80 years
with GE had different presentation at Emergency Department compared to
younger patients: they had higher gastrointestinal bleeding (24.9% vs.
16.3%; p = 0.001), anemization (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. Conclusions: Patients ≥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 to a different prognosis in this age group.