Frailty associated with poor outcomes after emergency laparotomy

Abstract

Background: Emergency laparotomy is a morbid and mortal operation that is often performed as a lifesaving treatment in the acutely unwell surgical patient. This study assessed morbidity and mortality in patients undergoing emergency abdominal surgery in an Australian metropolitan hospital to improve our understanding of factors that are associated with perioperative outcome. Methods: Patients were identified from a high-volume institution between 01 March 2018 and 01 February 2022. Baseline, operative and postoperative parameters were collected and analysed for associations with significant complications, defined as Clavien-Dindo (CD) scores of 3 or greater, using a binary logistic regression. Results: Independent predictors of ≥CD 3 complications were female sex (p=0.02, OR: 2.36 (95% CI 1.10, 5.05)) and frailty (p=0.03, OR: 2.30 (95% CI 1.03, 5.13)). Mortality rate in our cohort was 3.5%. Twelve of 13 deceased patients were female, all were frail and were of advanced age (mean 83.1 years). Conclusions: An improved recognition of frailty and the assessment of frailty in the acutely unwell surgical patient requiring an emergency laparotomy is required to aid perioperative assessment and decision making.