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Sociodemographic characteristics, such as sex, have been shown to influence health care delivery. Acute care surgery models are effective in decreasing mortality and morbidity after emergency surgeries, but sex-based differences in delivery and outcomes have not been explored. Our objective was to explore sex associated differences in the patient characteristics and clinical outcomes of those admitted to emergency general surgery. A post-hoc analysis of 512 emergency general surgical patients admitted consecutively to two tertiary care hospitals in Alberta Canada, between April 1, 2014 and July 31, 2015. We measured associations between sex and patient demographics, pre-, intra- and post-operative delivery of care, as well as post-operative outcomes. Of those excluded from the analysis, older females were more likely to undergo conservative management compared to older men (41% vs 34%, p = 0.03). Overall, there were no differences between sexes for time from admission to surgery, time spent in surgery, overall complication rate, mortality, hospital length of stay, or discharge disposition. Women were more likely to have a cancer diagnosis [OR 4.12 (95% CI: 1.61-10.5), p = 0.003, adjusted for age], while men were more likely to receive hernia surgery [OR 2.33 (95% CI 1.35-4.02), p = 0.002, adjusted for age and Charlson Comorbidity Index]. Finally, men were more likely to have a major respiratory complication [OR 2.73 (95% CI: 1.19-6.24), p = 0.02, adjusted for age]. Only two differences in peri and post-operative complications between sexes were noted, which suggests sex-based disparity in quality of care is limited once a decision has been made to operate. Future studies with larger databases are needed to corroborate our findings and investigate potential sex biases in surgical versus conservative management.

Delayed mobilization in older surgery patients is a major risk factor for postoperative complications, including functional decline, prolonged hospital stays, and a higher risk of hospital readmission. Although postoperative mobilization is a foundational nursing intervention, it is not consistently performed due to competing demands such as staffing shortages and high patient acuity. The Bedside Exercises for hospital FITness (BE-FIT) program is a patient-led rehabilitation initiative that shifts the traditional model of care by positioning patients as active participants in performing exercises after surgery, rather than relying on healthcare providers to carry out the exercises with them. This study aims to explore healthcare providers' experiences and perceptions of the delivery of the BE-FIT program to older postoperative patients in acute care surgical units and to identify strategies to improve program acceptance and sustainability. A qualitative descriptive design was implemented. Semi-structured in-person interviews were conducted with 14 healthcare providers who participated in BE-FIT implementation across four surgical units. Interviews were audio-recorded and data were analyzed using an inductive content analysis approach. Three themes emerged: (A) barriers and (B) facilitators for the implementation of the BE-FIT program, and (C) recommendations to enhance BE-FIT exercise uptake. Participants recognized the program's value in promoting early postoperative mobilization for older patients and appreciated the program's flexibility, simplicity, and patient-centred approach. However, operational barriers and patient resistance to mobilization affected implementation in clinical practice. Recommendations emphasized interdisciplinary engagement, integration into routine clinical workflows, family involvement, and leveraging technology. Healthcare providers perceive BE-FIT as a useful and adaptable tool to support early mobilization in older surgical patients. Insights gathered from frontline healthcare providers will inform strategies to improve the program's implementation, enhance adherence and support long-term sustainability.

Informed surgical consent requires accurate estimation of risks and benefits. Multiple risk assessment tools are available; however, most are not widely used or are specific to certain interventions. Assessing surgical risk is especially challenging in elderly patients because of their range of comorbidities, level of frailty, or severity of illness and a number of available surgical interventions. We searched MEDLINE from January 2014 to July 2017 for studies that used risk assessment tools in studies on elderly surgical patients. We then sought the original articles describing each assessment tool and subsequent validation studies. We identified risk assessment tools that can improve surgical risk assessment in elderly surgical patients. The majority of the identified tools are not commonly used for pre-operative risk assessment. NSQIP-PMP, mFI and SURPAS are promising tools. Age is commonly used to predict risk, but frailty may be a more appropriate measure. •The majority of risk assessment tools developed are not commonly used.•NSQIP-PMP, modified Frailty Index and SURPAS are promising assessment tools.•The use of frailty assessment during risk assessment may better predict outcomes.•Frailty should be incorporated into future risk assessment tools for the elderly.

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs . 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs . 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153

Surgical site infections can result in increases in morbidity, mortality, and health care costs. This video demonstrates the two recognized techniques for surgical hand preparation — water-based and waterless.

With health care costs increasing, the cost of caring for older adults is rising. Understanding the costs of surgical care for older adults is crucial in planning for health care services. We hypothesize that increasing age predicts increasing surgical inpatient costs. We conducted a retrospective analysis of general surgical inpatient costs at 4 hospitals over 2 fiscal years. We assessed the cost and number of procedures by age, procedure, hospital, cost category and surgical urgency. Costs were compared between surgical risk profile, urgency and age. Cost differences of 10% or more were considered clinically important. We examined the surgical inpatient costs for 12 070 procedures, representing 84% of all admissions in the region. The average cost was $4351 for scheduled admissions and $4054 for unscheduled admissions. Only unscheduled admissions resulted in higher costs in older age groups, more than doubling in patients aged 80 years and older undergoing low- and moderate-risk unscheduled surgery. The higher costs for older adults was primarily because of higher postoperative costs. In addition, the screening of candidates for elective surgery may have resulted in preoperative medical optimization leading to decreased admission costs. Older adults requiring surgery incur increased costs only if admitted for emergency surgery. The cost increase associated with unscheduled admissions was primarily for increased postoperative costs. Innovative programs to reduce costs for postoperative care for older adults undergoing emergency surgery should be investigated. Avec la hausse constante des coûts des soins de santé, prendre soin des adultes âgés coûte de plus en plus cher. Comprendre le coût des soins chirurgicaux chez la personne âgée est crucial pour la planification des soins de santé. Selon notre hypothèse, l’avancée en âge permet de prédire la hausse des coûts chez les maladies hospitalisés en chirurgie. Nous avons procédé à une analyse rétrospective des coûts d’hospitalisation en chirurgie générale dans 4 hôpitaux sur une période de 2 années financières. Nous avons évalué les coûts et le nombre d’interventions par âge, type d’intervention, hôpital, poste de dépense et urgence chirurgicale. Les coûts ont été comparés entre profil de risque chirurgical, urgence et âge. Les différences de coûts égales ou supérieures à 10 % étaient considérées cliniquement importantes. Nous nous sommes penchés sur les coûts d’hospitalisation pour 12 070 interventions, représentant 84 % de toutes les admissions dans la région. Le coût moyen était de 4351 $ pour les admissions planifiées et de 4054 $ pour les admissions non planifiées. Seules les admissions non planifiées ont entraîné des coûts plus élevés dans les catégories d’âge plus avancées, soit de plus du double chez les personnes de 80 ans et plus soumises à des interventions non planifiées assorties d’un risque faible et modéré. Les coûts plus élevés associés à l’âge avancé ont été générés principalement par les soins postopératoires. De plus, la sélection des personnes candidates à des chirurgies non urgentes peut avoir donné lieu à une optimisation médicale préopératoire, entraînant une baisse des coûts d’admission. Les adultes âgés qui doivent être opérés n’encourent des coûts plus élevés que s’ils sont admis pour une chirurgie urgente. La hausse des coûts associée à une admission non planifiée découle principalement de la hausse des coûts postopératoires. Il faudrait se pencher sur des programmes novateurs afin de réduire les coûts des soins postopératoires chez les adultes âgés soumis à des chirurgies urgentes.

Acute mesenteric ischemia (AMI) is a life-threatening condition that can result in multiple organ injury and death. A timely diagnosis and treatment would have a significant impact on the morbidity and mortality in high-risk patient population. The purpose of this study was to investigate if intestinal fatty acid binding protein (I-FABP) and α-defensins can be used as biomarkers for early AMI and resultant lung injury. C57BL/6 mice were subjected to intestinal ischemia by occlusion of the superior mesenteric artery. A time course of intestinal ischemia from 0.5 to 3 h was performed and followed by reperfusion for 2 h. Additional mice were treated with N-acetyl-cysteine (NAC) at 300 mg/kg given intraperitoneally prior to reperfusion. AMI resulted in severe intestinal injury characterized by neutrophil infiltrate, myeloperoxidase (MPO) levels, cytokine/chemokine levels, and tissue histopathology. Pathologic signs of ischemia were evident at 1 h, and by 3 h of ischemia, the full thickness of the intestine mucosa had areas of coagulative necrosis. It was noted that the levels of α-defensins in intestinal tissue peaked at 1 h and I-FABP in plasma peaked at 3 h after AMI. Intestinal ischemia also resulted in lung injury in a time-dependent manner. Pretreatment with NAC decreased the levels of intestinal α-defensins and plasma I-FABP, as well as lung MPO and cytokines. In summary, the concentrations of intestinal α-defensins and plasma I-FABP predicted intestinal ischemia prior to pathological evidence of ischemia and I-FABP directly correlated with resultant lung injury. The antioxidant NAC reduced intestinal and lung injury induced by AMI, suggesting a role for oxidants in the mechanism for distant organ injury. I-FABP and α-defensins are promising biomarkers, and may guide the treatment with antioxidant in early intestinal and distal organ injury.

Background Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home. Results Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007). Conclusion American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home.

Sepsis and septic shock are the leading causes of death in critically ill patients. Acute intestinal ischemia/reperfusion (AII/R) is an adaptive response to shock. The high mortality rate from AII/R is due to the severity of the disease and, more importantly, the failure of timely diagnosis. The objective of this investigation is to use nuclear magnetic resonance (NMR) analysis to characterize urine metabolomic profile of AII/R injury in a mouse model. Animals were exposed to sham, early (30 min) or late (60 min) acute intestinal ischemia by complete occlusion of the superior mesenteric artery, followed by 2 hrs of reperfusion. Urine was collected and analyzed by NMR spectroscopy. Urinary metabolite concentrations demonstrated that different profiles could be delineated based on the duration of the intestinal ischemia. Metabolites such as allantoin, creatinine, proline, and methylamine could be predictive of AII/R injury. Lactate, currently used for clinical diagnosis, was found not to significantly contribute to the classification model for either early or late ischemia. This study demonstrates that patterns of changes in urinary metabolites are effective at distinguishing AII/R progression in an animal model. This is a proof-of-concept study to further support examination of metabolites in the clinical diagnosis of intestinal ischemia reperfusion injury in patients. The discovery of a fingerprint metabolite profile of AII/R will be a major advancement in the diagnosis, treatment, and prevention of systemic injury in critically ill patients.

Aim The aim of this concept analysis paper is to explore the concept of stigma towards hospitalised older adults and propose a clear definition to understand this phenomenon. Design and Review Method Rodgers' evolutionary concept analysis method was used to evaluate the concept of stigma towards hospitalised older adults by identifying attributes, antecedents, and consequences. Data Sources A systematic search was conducted using CINAHL, PubMed, Scopus, and Google Scholar databases. Seventeen research articles from 1963 to 2025 were identified as directly related to the concept of stigma towards hospitalised older adults. Results Discrimination based on age, discriminatory practices, and negative stereotypes were the common attributes highlighted in research studies. The primary antecedent of stigma in hospitalised older adults is a social stigma which leads to stigmatised attitudes and practices towards older adults admitted into hospital. Inequalities in the hospital environment and lack of motivation are consequences that may provoke a stigmatised demeanour towards older patients in hospitals. Conclusion A clear understanding of stigma in the context of hospitalised older adults will guide the development of a conceptual framework and improve the healthcare professionals' care approach towards older adults in the hospital setting.