APEROLD study: acute peritonitis in the oldest nonagenarian patients with acute abdomen. Which is the fate?

This is a prospective, multicenter, observational study whose objective is to investigate the impact of emergency abdominal surgery versus nonoperative therapy on the outcomes of nonagenarians. All consecutive patients aged 90 years or older admitted to the surgical department for acute secondary peritonitis and undergoing urgent or emergency surgery or nonoperative management will be invited to participate. They can choose to consent or decline for a 30-day data collection period. The primary aim of this study is to evaluate early and late outcomes: 30-day and 1-year survival rates, clinical course and postoperative complications rate, and 1-year functional status. The secondary aim is to investigate which factors contribute to the choice of surgical intervention over nonoperative management, as well as the accuracy of risk scoring systems in predicting poor outcomes or functional loss: P-POSSUM score, American Society of Anesthesiologists (ASA) score, APACHE II score, Charlson's Comorbidity Index (CCI), Flemish version of the Triage Risk Screening Tool (fTRST), and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator. According to our experience, the time is ripe for large multicenter trials to establish an ultimate scoring system for statistical probability of survival or treatment success, with the ultimate goal of obtaining evidence to guide the management of the emergency in people older than 90 years.