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The following is a summary of “Extra-abdominal CT imaging indicates increased severity of illness in advanced age patients requiring emergency abdominal surgery,” published in the March 2025 issue of American Journal of Surgery by Malhotra et al.

Abdominal sepsis is a significant cause of morbidity and mortality in geriatric patients, often leading to neurologic and pulmonary dysfunction. This study hypothesizes that the need for extra-abdominal imaging in patients with abdominal sepsis undergoing emergency surgery is indicative of a greater burden of illness. A retrospective analysis was conducted on patients aged 65 years and older who underwent emergency abdominal surgery for sepsis. Patients were categorized into two groups: those who received abdominal-only imaging (AbdCT) and those who underwent both abdominal and extra-abdominal imaging (ExtraCT). Among the 127 patients included, 30 belonged to the ExtraCT group, while 97 were in the AbdCT group. Patients in the ExtraCT group had significantly higher rates of dementia (13.3% vs. 3.3%, p=0.03), diabetes (93.3% vs. 60.1%, p<0.01), and chronic obstructive pulmonary disease (COPD) (70% vs. 29.9%, p<0.01) compared to those in the AbdCT group. 

Notably, ExtraCT patients were less likely to present with abdominal pain as their chief complaint (23.3% vs. 81.4%, p<0.01) but were more frequently qSOFA positive (33.3% vs. 7.2%, p<0.05), indicating a higher severity of illness. Despite these differences, the time to the operating room was not significantly different between the groups. However, the ExtraCT group exhibited a markedly higher 30-day mortality rate (33.3% vs. 5.2%, p<0.01). Multivariate analysis revealed that undergoing extra-abdominal imaging was associated with a significantly increased risk of mortality (OR=5.4; 95% CI=1.4–20.1). These findings suggest that the need for extra-abdominal imaging in geriatric patients with abdominal sepsis serves as a marker of severe illness. Given the strong association with poor outcomes, the presence of extra-abdominal pathology should prompt early discussions regarding prognosis and end-of-life decision-making.

Source: americanjournalofsurgery.com/article/S0002-9610(25)00119-9/abstract