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

Objective To analyse and compare the clinical outcomes between patients >= 80 years and 65-79 years, who presented to our emergency department (ED) with the two most common gastric emergency (GE) clinical presentation, that is, gastric bleeding and gastric perforation. Design Single-centre retrospective cohort study. Participants A total of 1011 patients were enrolled: 421 patients aged >= 80 years were compared with 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 presentations at ED compared with younger patients: they had higher gastrointestinal bleeding (24.9% vs 16.3%, p=0.001), anemisation (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 with a different prognosis in this age group.