Preoperative physical functional status affects the long-term outcomes of elderly patients with open abdomen.

Aim: The mortality rates among elderly patients with open abdomen (OA) are high, and pre-existing comorbidities could affect the outcomes. However, long-term prognosis remains uncertain. We examined long-term outcomes in elderly patients with OA, focusing on physical functional status.
Methods: We undertook a retrospective cohort study between 2007 and 2017 at a single institution. Patients with OA who were aged ≥65 years were categorized into two groups: "good preoperative functional status" group (GFG) and "poor preoperative functional status" group (PFG). The GFG was defined as Eastern Cooperative Oncology Group/World Health Organization performance status (PS) 0-1, whereas PFG was defined as PS 2-4. The primary outcomes were survival and PS 2 years following the initial surgery.
Results: Of the 53 participants, 38 and 15 were assigned to the GFG and PFG, respectively. The PFG (median age, 81 years) was older than the GFG (median age, 75.5 years; P  = 0.040). The 2-year survival rate was 39.5% in GFG and 6.7% in PFG, and Kaplan-Meier analysis showed significant difference ( P  = 0.022). Among all patients, the PS at 2 years was worse than that at discharge ( P  = 0.007). Preoperative PS was correlated with 2-year survival ( P  = 0.003), whereas age and pre-existing comorbidities were not.
Conclusion: The long-term outcomes of elderly patients with OA are affected by the preoperative physical functional status. Functional status deteriorates in a time-dependent manner. Therefore, surgery requiring OA must be carefully considered for elderly patients with PS 2 or higher.
Competing Interests: Approval of the research protocol: This study was approved by the ethics committee of the National Health Organization Disaster Medical Center and it conforms to the provisions of the Declaration of Helsinki. Approval No. 2020‐8. Informed consent: The ethics committee did not require informed consent from patients for observational studies using anonymous data such as those used in this study. Registry and the registration no. of the study/trial: N/A. Animal studies: N/A. Conflict of interest: None.
(© 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)