Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Abstract

Background Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge. Methods The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level. Results A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit. Conclusion Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.

Frailty in older patients undergoing emergency colorectal surgery: USA National Surgical Quality Improvement Program analysis

“…In addition, ELF used the Clinical Frailty Score from the Canadian Study of Health and Aging, which has seven subjective categories based on a patient's functional level and degree of control over medical conditions, whereas the mFI‐5 uses five routinely available objective variables. The significant association between increasing frailty severity and increased risk of poor postoperative outcomes and loss of independence at discharge in the ELF studies is corroborated here 14,27 .…”

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

“…1). Six studies from five cohorts were included (five full studies and partial data from one study including colorectal and upper gastrointestinal surgery only) [26][27][28][29][30][31]. The main reason for the exclusion of full texts was if frailty was measured by alternative methods other than the Clinical Frailty Scale or Modified Frailty Index, or not measured at all.…”

“…Study patients were enrolled between June 2012 and April 2019. They were conducted in the United Kingdom [26,28,29,31], Singapore [27], and Spain [30]. Five of them reported frailty measured by the Clinical Frailty Scale [26,[28][29][30][31] and only one by the Modified Frailty Index [27].…”

“…They were conducted in the United Kingdom [26,28,29,31], Singapore [27], and Spain [30]. Five of them reported frailty measured by the Clinical Frailty Scale [26,[28][29][30][31] and only one by the Modified Frailty Index [27]. Inclusion criteria were 65 for four studies [26][27][28][29], and 70 and 75 for the two other studies [30,31].…”

Study protocol for the COPE study: COVID-19 in Older PEople: the influence of frailty and multimorbidity on survival. A multicentre, European observational study

“…OPSOC has a proven record of conducting high-quality research and successfully publishing results relating to outcomes for older people [29][30][31][32]. OPSOC has an international reputation, related specifically to the care of the frail older person.…”