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Role of infection in increased mortality associated with age in laparotomy.

Mortality in patients undergoing laparotomy increases with age of the patient. Concomitantly other morbid perioperative factors also are increased, including number and grade of associated system diseases, preoperative infections, severity of disease, emergency operations, post-operative infectious and noninfectious complications, organ failures, and forced secondary operations. All these and other factors may play a role in mortality but two patterns of death are predominant. Some elderly patients present in shock from blood loss or with overwhelming sepsis and die at operation or shortly thereafter. The majority of others who die have intra-abdominal infections preoperatively or they develop infectious complications and these initiate or perpetuate a train of morbid events that prove fatal after days or weeks of intensive supportive therapy. The inability of elderly patients to avoid or to recover from infection appears to be the most common causative factor in increased mortality with age in laparotomy patients.