[Management of patients over 75 years of age with digestive or abdominal disease. A series of 660 cases].

Over a period of 3 years, the authors cared for 660 patients over 75 years of age with diseases of the digestive tract. In 180 cases, the initial hospitalization had been previously planned and in 480 (72.7%) emergency admission was necessary. The diagnosis had not been confirmed in 90% of the emergency admissions. Half of the patients suffered from major illness (ASA III, IV). Planned hospitalization in a surgical unit involved cancer in 60% of the cases among which about one-half were colorectal cancers. In this latter group, mean hospitalization was 12 days and hospital mortality was 9.7%. For the patients with emergency admissions, diagnosis was only established after exploratory examinations (echography 296, endoscopy 205, opacification of the digestive tract 157...). No diagnosis could be established in 1.6% of the patients. Four types of emergency patients could be identified: occlusions 39.6%, painful abdomen 37%, haemorrhage 13.9% and jaundice 7.7%. In these groups, surgery was required in 64.7%, 69.1%, 72% and 40.5%, and mortality was 21.9%, 20.3%, 21.6% and 8.1% respectively. Duration of hospitalization was however similar (12 days). The overall mortality in this series was 14% (5.7% in non-operated patients and 16.7% in operated patients with a distinction between planned operations, 9.7%, and emergency operations, 20.3%). The two main risk factors were underlying disease and the need for emergency surgery. Age over 90 was also aggravated prognosis.