Comprehensive evaluation of the patient with multiple underlying conditions

At 17:30 on August 20, 2026, elderly woman Tran Thi Dam (97 years old, residing in Ha Nam) was transferred to the Bach Mai Hospital, Ninh Binh branch, in a state of acute abdominal pain.

Through examination and necessary paraclinical tests, doctors diagnosed the patient with acute appendicitis with a fecalith at the base of the appendix, accompanied by inflammatory reactions in the surrounding adipose tissue.

Surgical treatment in a 97-year-old patient inherently conceals many risks. In this case, the condition of severe multi-pathology made the surgery even more complex.

Assessment results showed that the heart's contractile function was severely reduced, with an ejection fraction (EF) of only 29%, accompanied by mitral regurgitation and an elevated NT-proBNP level of 9,542 pg/mL, indicating severe heart failure.

In addition, the patient suffered from stage III renal failure with a creatinine level of 306 µmol/L, high blood potassium at 6.1 mmol/L—a level posing a risk of cardiac arrhythmias—along with severe anemia.

Given the above condition, proceeding with surgery immediately would put the patient at high risk for intraoperative and postoperative complications related to cardiovascular, renal, and electrolyte disorders.

Multidisciplinary consultation, careful preoperative preparation

To ensure the safety of the patient, right through the night, the Bach Mai Hospital, Ninh Binh branch, organized an inter-specialty consultation involving doctors from Surgery, Anesthesiology and Resuscitation, Intensive Care, Cardiology, and Nephrology - Dialysis.

Instead of operating immediately, the treatment team agreed to prioritize stabilizing medical disorders before surgery. The patient underwent emergency hemodialysis via a femoral vein catheter to rapidly control hyperkalemia and balance acid-base status; at the same time, she received volume replacement and blood transfusions to improve her anemia.

After her biochemical and hemodynamic indices gradually stabilized, the patient underwent laparoscopic appendectomy.

During the surgery, the team managed the lesions, resolved the infection site, and controlled the operation time, thereby minimizing the impact on the patient's circulatory system.

Intensive resuscitation, continuous treatment after surgery

Postoperatively, resuscitation work received special attention. In the Intensive Care Unit, the patient was closely monitored for hemodynamic indices, arrhythmia control, and respiratory support using non-invasive ventilation (NIV), under the charge of CKII Dr. Nguyen Ba Cuong and his colleagues.

When her condition passed the critical stage, the patient was transferred to the Cardiology Department to continue specialized medical treatment undertaken by CKII Dr. Le Van Tuan and the team of physicians and nurses.

The treatment regimen was appropriately adjusted to support heart function, control hemodynamics, and maximally preserve renal function.

Thanks to the coordination among specialties, the patient step-by-step overcame the critical stage. Currently, Mrs. Dam is alert, her health is stable, and she can eat and engage in light activities.

Looking back at the case, Assoc. Prof. Dr. Dao Xuan Co - Secretary of the Party Committee, Director of Bach Mai Hospital - shared: “The most noble mission of a physician is to reclaim life for the patient at all costs, regardless of age or circumstance. The presence of Bach Mai Hospital's facility in Ninh Binh is not simply about expanding scale, but about bringing the full quintessence of tertiary-level medicine, modern equipment, and leading experts to serve the People.

Seeing the 97-year-old elderly woman spectacularly overcome the gates of death to return in peace to the embrace of her children and grandchildren, we are even more firmly convinced that the direction of bringing specialized healthcare close to the people, allowing citizens to enjoy high-tech procedures right in their hometown, is completely correct and immensely humane."

The recovery of Mrs. Dam is the result of a comprehensive evaluation process, handling each acute issue and continuous coordination among multiple specialties. This is also one of the important requirements when treating elderly patients with multiple underlying conditions, especially in cases requiring surgical intervention.

The success of the case not only brings joy to the patient and her family, but also demonstrates the role of the multidisciplinary coordination model in treating complex cases at the Bach Mai Hospital, Ninh Binh branch.

Kim Long - Le Dat