Frailty and post operative outcomes in geriatric patients undergoing emergency laparotomy in Indian population

Abstract

Background: With an increase in the number of emergency laparotomies performed on geriatric age group, there is an urgent need to develop preoperative optimisation strategies for these vulnerable patients. Frailty being a common occurrence in this age group and a measurable index can be used to prognosticate such patients. Hence the study was aimed to determine the prevalence and influence of frailty on mortality and morbidity of geriatric patients undergoing emergency laparotomy. Methods: A prospective observational study carried out in the Department of Surgery, SCB Medical College and Hospital, Cuttack, India from March 2021 to December 2021. All older adults undergoing emergency laparotomy were included in the study. Preoperative clinical frailty score (CFS) was calculated from 1 (very fit) to 7 (severely frail). The outcome of the study being 30 day postoperative mortality, length of hospital stay and post operative complications were analysed. Result: A total of 110 older adults underwent emergency laparotomy. Frailty was present in 30.9%. The overall 30 day post operative mortality was 12.7%. The risk of 30 day mortality was associated with frailty: CFS 6/7 odds ratio 4.2 (26.3%). Similar associations were seen with length of hospital stay and post operative complications. Conclusion: Frailty being present in nearly one third of older patients undergoing emergency laparotomy, is associated with greater risk of post operative mortality and morbidity. Frailty scoring must be integrated in routine preoperative assessment of geriatric patients undergoing emergency laparotomy which can help in the decision making process.