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Invited Critique
December 21, 2009

Getting Old Shouldn't Be an EmergencyComment on “Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients”

Arch Surg. 2009;144(12):1162. doi:10.1001/archsurg.2009.202

As a Baby Boomer, I find this article depressing. Whatever happened to “65 is the new 45”? McGillicudy et al have provided us with a picture of worsening outcomes as our population ages, especially if the patient presents at the end of the disease spectrum when emergency care becomes necessary. The authors emphasize that preventive care for patients in the area of colorectal disease as well as comorbidities will benefit the patient and society. The high perforation/obstruction rate for colorectal cancer in the group (30%) suggests that education of primary care physicians and patients regarding appropriate screening measures may be a useful way to spend a portion of President Obama's stimulus package. This might lead to a reduction of medical expenditures as emergency care costs and the high cost of complications disappear without penalizing physicians for allowing “never” events to occur in high-risk patients. The authors also emphasize that a raised level of awareness and appropriate surveillance for cardiopulmonary complications in this patient population may improve outcomes. Because all patients older than 65 years have access to health care already, access to care should not be as significant a factor as the authors suggest. Once again, awareness on the part of patients and primary care physicians is important.

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