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

Abstract

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.

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

“…Outcome 3McGuckin et al [26] 2018 **** *** Tan et al [27] 2019 **** * Parmar et al [28] 2019 **** ** *** Carter et al [29] 2020 **** ** *** Arteaga et al [30] 2020 **** *** Vilches-Moraga et al [31] 2020 *** * ***…”

“…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

“…This association with frailty is present in geriatric medicine and across a range of ages, specialties and interventions. [16][17][18][19] As a result, hospital teams are encouraged to routinely score frailty in adults. 20 21 Frailty is more widely used than age alone as a trigger for specialist resource allocation, pathway decision aid and in shared decision-making in older patients.…”