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

Abstract

BackgroundFrailty, a “syndrome of loss of reserves,” is a decade old concept. Initially it was used mainly in geriatrics but lately its use has been extended into other specialties including surgery. Our main objective was to examine the association between frailty and mortality, between frailty and length of hospital stay (LOS) and frailty and readmission within 30 days in the emergency surgical population.MethodsStudies reporting on frailty in the emergency surgical population were eligible. MEDLINE (via PubMed), EMBASE, Scopus, CENTRAL, and Web of Science were searched with terms related to acute surgery and frail*. We searched for eligible articles without any restrictions on the 2nd of November 2020. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI), using a random effect model. Risk of bias assessment was performed according to the recommendations of the Cochrane Collaboration. As the finally selected studies were either prospective or retrospective cohorts, the “Quality In Prognosis Studies” (QUIPS) tool was used.ResultsAt the end of the selection process 21 eligible studies with total 562.070 participants from 8 countries were included in the qualitative and the quantitative synthesis. Patients living with frailty have higher chance of dying within 30 days after an emergency surgical admission (OR: 1.99; CI: 1.76–2.21; p < 0.001). We found a tendency of increased LOS with frailty in acute surgical patients (WMD: 4.75 days; CI: 1.79–7.71; p = 0.002). Patients living with frailty have increased chance of 30-day readmission after discharge (OR: 1.36; CI: 1.06–1.75; p = 0.015).ConclusionsAlthough there is good evidence that living with frailty increases the chance of unfavorable outcomes, further research needs to be done to assess the benefits and costs of frailty screening for emergency surgical patients.Systematic Review RegistrationThe review protocol was registered on the PROSPERO International Prospective Register of Systematic Reviews (CRD42021224689).

The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings – A Systematic Review of the Literature

“…However, there are studies that show that although the type of therapy or level of care is used as a controlling factor in the analysis, the predictive ability of the CFS remains unchanged. 20 , 24 , 56 , 58 Secondly, we used the QIUPS tool as recommended by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. It is possible that utilizing another quality assessment tool would have influenced our final sample of included studies.…”

“…Previous systematic reviews have examined the psychometric properties of different frailty assessment tools in various clinical settings. 7 , 16–18 , 21 , 22 The CFS shows good accuracy and feasibility, a strong association with mortality, a higher care level, 23 , 24 and good inter-rater reliability. 19 Although these literature reviews on frailty suggest that the CFS is a promising frailty assessment tool, none of these have explicitly focused on the CFS in older patients in acute clinical settings in which frailty assessment is fundamental for guiding patient care and helping clinicians determine which interventions will be beneficial or harmful to the older patient.…”

Study protocol for a national observational cohort investigating frailty, delirium and multimorbidity in older surgical patients: the third Sprint National Anaesthesia Project (SNAP 3)

“…3 33-36 This association was further demonstrated in a systematic review of acute surgical patients by Leiner et al In this meta-analysis, those living with frailty experienced an increased length of stay with a weighted mean difference of 4.75 days (95% CI 1.79 to 7.71, p=0.002). 28 A further meta-analysis by Panayi et al found that surgical patients living with frailty were more likely to experience postoperative complications (RR of 1.48, 95% CI 1.35 to 1.61, p<0.001), readmission (RR of 1.61, 95% CI 1.44 to 1.80, p<0.001) and discharge to skilled care (risk ratio of 2.15, 95% CI 1.92 to 2.40, p<0.001). 29 Routine assessment and management of frailty, multimorbidity and risk of postoperative delirium can reduce the likelihood of adverse outcomes in older patients.…”

“…The influence of frailty on a range of patient outcomes including postoperative quality of life, mortality, morbidity, reoperation, length of stay, readmission and discharge to residential care is widely reported 3 4 6 27–29. A review of older surgical patients by Lin et al demonstrated a significant relationship with 12-month mortality, finding an OR of 1.1–4.97 for those living with frailty, compared with patients who were not frail 3 30 31.…”

Personalized Medicine in Acute Care Surgery: Are We Ready to Deal with Our Failures?

“…The defect was associated with an increased mortality rate compared with non-frail patients (OR 4.3, 95% CI 2.25–8.19%, p < 0.05, I 2 = 80%). [ 11 ] Moreover, a meta-analysis demonstrated that frailty is a good marker for ultimately poor outcomes and may also be associated with prolonged hospital stay and the need for readmission [ 12 ]. The authors concluded that the frailty scoring system should be integrated into acute surgical assessment practice to aid decision making and the development of novel postoperative strategies [ 13 ].…”