Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Abstract

Purpose The purpose of this review was to determine the association between frailty and mortality among adults ≥ 65 years old undergoing emergency general surgery (EGS). Methods This systematic review followed the PRISMA guidelines (CRD42020172482 on PROSPERO). A search in MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews was conducted from inception to March 5, 2020. Studies with patients ≥ 65 years undergoing EGS were included. The primary exposure was frailty, measured using the Clinical Frailty Scale or the Modified Frailty Index. The primary outcome was 30-day mortality. Secondary outcomes were 90-day and 1-year mortality, length of stay, complications, change in level of care at discharge, and loss of independence. Two independent reviewers screened articles and extracted data. Risk of bias was assessed according to the Newcastle–Ottawa Scale and quality of evidence was assessed using the GRADE approach. A meta-analysis was performed for 30-day mortality using a random-effects model. Results Our search yielded 847 articles and six cohort studies were included in the systematic review. There were 1289 patients, 283 being frail. The pooled OR from meta-analysis for frail compared to non-frail patients was 2.91 (95% CI 2.00, 4.23) for 30-day mortality. Frailty was associated with increased odds of all secondary outcomes. Conclusion Frailty is significantly associated with worse outcomes after emergency general surgery in adults ≥ 65 years of age. The Clinical Frailty Scale could be used to improve preoperative risk assessment for patients and shared decision-making between patients and healthcare providers. Registration number CRD42020172482 (PROSPERO).

Frailty and Emergency Surgery: Results of a Systematic Review and Meta-Analysis

“…Two previous meta-analyses published in the past 5 years investigated frailty in emergency surgical patient group ( 38 , 39 ). Although our results are in line with their conclusion, there are some significant differences in the methodology.…”

“…Conversely heterogeneity might not be important in the CFS subgroup ( I 2 =8.7%; p = 0.363). Fehlmann et al reported a significant association between frailty and length of hospital stay (adjusted ORs were 1.21, 1.26, 1.48, 1.44, and 1.62 for CFS 2, 3, 4, 5, and 6–7, respectively) ( 39 ). When we analyzed all the available data, we also found significant relationship between frailty and length of hospital stay.…”

Emergency Surgery Score as an Effective Risk Stratification Tool for Patients Undergoing Emergency Surgeries: A Narrative Review

“…The presence of frailty in elderly patients undergoing emergency surgery is also responsible for postoperative mortality, complications, prolonged length of hospital stay, and the loss of independence after surgery [ 29 ]. Kennedy et al suggested that frailty scoring should be incorporated into preoperative acute surgical assessment to help in decision-making and for developing novel postoperative strategies [ 30 ].…”

Clinical Frailty Scale as a predictor of short‐term mortality: A systematic review and meta‐analysis of studies on diagnostic test accuracy

“…In 2003, the American Geriatrics Society proposed future studies to develop appropriate screening tools for recognizing high‐risk older patients 7 . Subsequent efforts aimed at identifying reliable frailty screening tools suitable for the ED context; currently, several such tools are available and their effectiveness is evaluated based on the rates of ED revisit, hospitalization, and mortality 8,9 . In addition, previous studies have compared diagnostic accuracy and ease of use of different frailty screening tools 10,11 .…”