Frailty in Older Patients Undergoing Emergency Laparotomy

Abstract

Objective: This study aimed to document the prevalence of frailty in older adults undergoing emergency laparotomy and to explore relationships between frailty and postoperative morbidity and mortality. Summary Background Data: The majority of adults undergoing emergency laparotomy are older adults (≥65 y) that carry the highest mortality. Improved understanding is urgently needed to allow development of targeted interventions. Methods: An observational multicenter (n=49) UK study was performed (March–June 2017). All older adults undergoing emergency laparotomy were included. Preoperative frailty score was calculated using the progressive Clinical Frailty Score (CFS): 1 (very fit) to 7 (severely frail). Primary outcome measures were the prevalence of frailty (CFS 5–7) and its association to mortality at 90 days postoperative. Secondary outcomes included 30-day mortality and morbidity, length of critical care, and overall hospital stay. Results: A total of 937 older adults underwent emergency laparotomy: frailty was present in 20%. Ninety-day mortality was 19.5%. After age and sex adjustment, the risk of 90-day mortality was directly associated with frailty: CFS 5 adjusted odds ratio (aOR) 3.18 [95% confidence interval (CI), 1.24–8.14] and CFS 6/7 aOR 6·10 (95% CI, 2.26–16.45) compared with CFS 1. Similar associations were found for 30-day mortality. Increasing frailty was also associated with increased risk of complications, length of Intensive Care Unit, and overall hospital stay. Conclusions: A fifth of older adults undergoing emergency laparotomy are frail. The presence of frailty is associated with greater risks of postoperative mortality and morbidity and is independent of age. Frailty scoring should be integrated into acute surgical assessment practice to aid decision-making and development of novel postoperative strategies.

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 .…”

“…Nearly one‐third of patients in this study were frail, and frailty was associated with complications, duration of hospital stay, post discharge nursing needs and readmission. The ELF (Emergency Laparotomy and Frailty) study 14 reported frailty in 20 per cent of elderly patients undergoing emergency laparotomy in the UK. The discrepancy may be due to differences in the procedures performed, as only colorectal procedures were included here 26 .…”

“…Frailty is a measure of increased vulnerability and decreased physiological reserve to stressors, such as surgery, which impairs recovery and return to preoperative functional level 12,13 . It affects as many as 20 per cent of elderly patients, and may be associated with mortality, postoperative complications and longer hospital stay after surgery 4–7,14–16 .…”

Working Collaboratively: Outcomes of Geriatrician Input in Older Patients Undergoing Emergency Laparotomy in a District General Hospital

“…Frailty is a compelling indicator of mortality, LOS, and readmission within 30 days and it has been recognized as a distinct entity from increasing age alone [14][15][16]. Studies have shown that one-fifth of older adults and 16% of younger adults presented with surgical emergencies are deemed to have frailty [17][18]. It may be that a frailty assessment on admission proves more beneficial at identifying patients in need of additional care than age.…”

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.…”