A Simple Screening Tool to Predict Outcomes in Older Adults Undergoing Emergency General Surgery

Abstract

Objectives To determine whether the Flemish version of the Triage Risk Screening Tool (fTRST) can be used to accurately assess frailty in an emergency setting. Design Prospective observational study. Setting of a tertiary referral hospital. Patients All individuals aged 70 and older consecutively admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 who met inclusion criteria (N=110). Measurements Individuals were screened with the fTRST and additional metrics such as the age‐adjusted Charlson Comorbidity Index and American Society of Anesthesiology score. Thirty‐ and 90‐day postoperative complications where recorded. Regression analyses were performed to identify possible preoperative predictors of adverse outcomes. Results Thirty‐day major complications (Clavien‐Dindo Classification 3–5) occurred in 28.2% of participants (n=31). fTRST had the highest correlation with major complications (odds ratio (OR) = 7.42). All participants who died within 30 days of surgery has a fTRST score of 2 or greater (area under the receiver operating curve (AUC)=71.3). When risk factors for overall 90‐day mortality were analyzed, a fTRST score of 2 or greater had sensitivity of 96% (95% confidence interval CI=79.6–99.9%), specificity of 43.5% (95% CI=32.8–54.7%) (AUC=69.8%; OR=18.50, 95% CI=2.39–143.11, p = .005). The average length of hospital stay was more than twice as long in the group with a fTRST score of 2 or greater (15.2 days) than in those with a score less than 2 (6.6 days) (p = .005). Conclusion The fTRST is an effective tool to predict mortality, morbidity, and length of stay after emergency surgery and can therefore be used to anticipate postoperative course, determine care goals, and plan for involvement of a dedicated geriatric care team. J Am Geriatr Soc 67:309–316, 2019.

A retrospective observational study of enhanced recovery after surgery in older patients undergoing elective colorectal surgery

“…The fTRST showed a trend to predict postoperative complications (p = 0.066) and was associated with prolonged postoperative LOS in univariable analysis (p = 0.006). A prospective study in emergency abdominal surgery observed an association between the fTRST (cut-off �2), postoperative complications and postoperative LOS [31].…”

Prediction of functional loss in emergency surgery is possible with a simple frailty screening tool

“…The most important risk factor for functional decline is frailty [4,8,9]. The surgeon has few instruments to predict a postoperative functional loss in the busy emergency setting where a frailty assessment in not available or reliable [2,7,10]. A short frailty screening tool validated in a previous study, the Flemish version of the Triage Risk Screening Tool (fTRST), is effective in predicting 30-and 90-day morbidity and mortality after emergency abdominal surgery among older patients (≥70 years) [10].…”

Suggestion For a New Classification of Postoperative Neurological Complications (CPNC) in Neurosurgery

“…The general surgical eld has already proposed a "Classi cation of Surgical Complications" by Clavien & Dindo. This standardized classi cation is nowadays widely applied in various surgical disciplines, and it is declared as an effective instrument for quality management [6,10,12,13,17,19,21,23,26]. The lack of such standardized classi cation is a subject of discussion over a long time in the neurosurgical eld.…”