98frailty in Older Patients Undergoing Emergency Laparotomy: Further Results From the Elf Study (Emergency Laparotomy and Frailty)

Parmar, Kat; Law, Jennifer; Carter, B; Hewitt, Jonathan; Boyle, J M; Casey, Patrick; Maitra, Ishaan; Farrell, Ian; Pearce, Lyndsay; Moug, Susan

doi:10.1093/ageing/afz063.07

Cited by 51 publications

(89 citation statements)

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“…According to multivariate analysis, the presence of clinical frailty, as evidenced by a Clinical Frailty Score of 5 or above, was the strongest predictive factor, surpassing others indicators such as high ASA class. Previous research reported increased mortality in frail patients at 30 and 90 days [ 13 ], and retrospectively at 12 months [ 14 ], but to date this is the first study communicating long-term prospective frailty data.…”

Section: Discussionmentioning

confidence: 99%

Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

et al. 2020

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Introduction Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Methods Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. Results 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

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Section: Discussionmentioning

confidence: 99%

Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

et al. 2020

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“…Older patients who undergo intra-abdominal surgery are often frail and have complicating underlying medical comorbidities [1][2][3][4] which mean these operations are associated with significant post-operative morbidity and mortality [5]. In contrast to planned surgery, there is less time to prepare emergency patients preoperatively, although such preparations would be valuable in this patient group [6].…”

Section: Introductionmentioning

confidence: 99%

“…A comprehensive understanding of not just survival, but also of the flow of older patients through hospital services is required to ensure that healthcare systems meet the needs of older people. Older survivors of intra-abdominal procedures may experience reduced independence, have different rehabilitation needs and a greater risk of requiring long-term residential care [2]. Healthcare systems must plan for these aspects to achieve best outcomes and avoid unwanted adverse impacts on provision of other hospital services.…”

Section: Introductionmentioning

confidence: 99%

Discharge outcomes among elderly patients undergoing emergency abdominal surgery: registry study of discharge data from Irish public hospitals

et al. 2020

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Background: Intra-abdominal emergency surgery is associated with high mortality risk and long length of hospital stay. The objective of this study was to explore variations in surgery rates, the relationship between admission source and discharge destination, and whether the postoperative length of stay was related to nursing home capacity in Irish counties. Methods: Data on emergency hospital episodes for 2014-18 for patients aged over 65 years with a primary abdominal procedure code were obtained from the National Quality Assurance Improvement System. Data on population and nursing home capacity were obtained from the Central Statistics Office and the Health Information and Quality Authority. Episode rates per 100,000 were estimated for sex and age groups and compared between 26 Irish counties. The association between admission source and discharge destination was explored in terms episode numbers, length of stay and mortality. A negative binomial regression model estimated casemix adjusted excess post-operative length of stay. The correlation between excess post-operative length of stay and nursing home capacity was explored by linear regression. Results: Overall, 4951 hospital episodes were included. The annual surgery rate ranged from 100 episodes per 100, 000 65-69 years old to 250 per 100,000 85-89 year old men. 90% of the episodes were admitted from patients' home. Four in five of these patients returned to their home while 12.7% died at hospital. The proportion of episodes where patients returned to their home reduced to two in five for those aged 85-89 years. The postoperative length of stay was 13.6 days longer (p < 0.01) for episodes admitted from home and discharged to nursing home in comparison with episodes discharged home. A negative association (p = 0.08) was found between excess post-operative length of stay and county-level nursing home capacity. Conclusions: This study provides relevant information to support informed consent to surgery for patients and clinicians and to improve the provision of care to older patients presenting with intra-abdominal emergencies.

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“…In the surgical setting, such an acquired reduction in resilience is associated with more frequent postoperative complications, a longer length of hospital stay, higher mortality rates at 30 days and 12 months after surgery, and a greater chance of dependent living at hospital discharge. 2,3 The association between frailty and increased risk of adverse postoperative clinician-reported, patient-reported and process-related outcomes has now been reported across all major surgical specialties, emergency and elective settings, and following critical care admission. 4 Perioperative medicine is being established to provide optimal preoperative, intraoperative and postoperative care for all patients, but with a particular focus on those at high risk of adverse postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Frailty in the perioperative setting

2019

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The frailty syndrome is defi ned as a decrease in physiological reserve across multiple organ systems leading to increased vulnerability to external stressors. Studies across surgical subspecialties and in emergency and elective settings have identifi ed frailty as an independent predictor of adverse postoperative clinician-reported, patient-reported and process-related outcomes. Although frailty is not specifi c to the older population, it is associated with ageing and therefore is increasingly observed in the ageing surgical population. Identifying frailty early in the perioperative pathway affords the opportunity to assess risk, modify the syndrome, inform shared decision making and plan the surgical pathway. Multiple tools to screen and diagnose frailty exist with limited appraisal of clinometric properties. A pragmatic approach to these tools is advocated with a future focus on collaborative approaches to modify the syndrome using multicomponent methodology such as comprehensive geriatric assessment and adapt the pathway to the needs of the frail surgical patient.

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98frailty in Older Patients Undergoing Emergency Laparotomy: Further Results From the Elf Study (Emergency Laparotomy and Frailty)

Cited by 51 publications

References 0 publications

Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

Discharge outcomes among elderly patients undergoing emergency abdominal surgery: registry study of discharge data from Irish public hospitals

Frailty in the perioperative setting

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