Functional performance and 30-day postoperative mortality after emergency laparotomy—a retrospective, multicenter, observational cohort study of 1084 patients

Abstract

Background: Despite the importance of predicting adverse postoperative outcomes, functional performance status as a proxy for frailty has not been systematically evaluated in emergency abdominal surgery. Our aim was to evaluate if the Eastern Cooperative Oncology Group (ECOG) performance score was independently associated with mortality following high-risk emergency abdominal surgery, in a multicentre, retrospective, observational study of a consecutive cohort. Methods: All patients aged 18 or above undergoing high-risk emergency laparotomy or laparoscopy from four emergency surgical centres in the Capitol Region of Denmark, from January 1 to December 31, 2012, were included. Demographics, preoperative status, ECOG performance score, mortality, and surgical characteristics were registered. The association of frailty with postoperative mortality was evaluated using multiple regression models. Likelihood ratio test was applied for goodness of fit. Results: In total, 1084 patients were included in the cohort; unadjusted 30-day mortality was 20.2%. ECOG performance score was independently associated with 30-day mortality. Odds ratio for mortality was 1.70 (95% CI (1.0, 2.9)) in patients with ECOG performance score of 1, compared with 5.90 (95% CI (1.8, 19.0)) in patients with ECOG performance score of 4 (p < 0.01). Likelihood ratio test suggests improvement in fit of logistic regression modelling of 30-day postoperative mortality when including ECOG performance score as an explanatory variable. Conclusions: This study found ECOG performance score to be independently associated with the postoperative 30-day mortality among patients undergoing high-risk emergency laparotomy. The utility of including functional performance in a preoperative risk assessment model of emergency laparotomy should be evaluated.

Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study

“…Some studies suggested that the number of walking steps was related to performance status [ 31 ]. As performance status is also one of the important factors for surgical indication and outcome [ 32 ], the pattern of the decrease and recovery in walking steps after NACRT is likely to be an indicator for the continuation of follow-up surgery or a predictor for postoperative mortality in patients with esophageal cancer.…”

Meta-analysis of mortality risk in octogenarians undergoing emergency general surgery operations

“…Octogenarians versus patients aged 70 to 79. Analysis of 19,407 patients from 4 studies 11,15,19,28 showed that the risk of 30-day mortality was significantly higher in octogenarians compared with patients aged 70 to 79 (OR: 1.21, 95% CI 1.13e1.31; P < .00001) (Fig 4, C). The between-study heterogeneity was low (I 2 ¼ 0%, P ¼ .65), and the certainty of the evidence was judged to be high (Supplementary Table 2).…”

Worse ECOG-PS Is Associated with Increased 30-Day Mortality among Adults Older than 90 Years Undergoing Non-Cardiac Surgery: A Single-Center Retrospective Study

“…The following parameters were analyzed: age, gender, body mass index (BMI), ASA-PS, pre-operative Charlson score 6 , the pre-operative fall risk assessment 7 , mFI-5 8 , ECOG-PS 9 , type of anesthesia, indication(s) for surgery, surgery site, duration of anesthesia, duration of surgery, volume of fluid administered during surgery, volume of blood loss, the presence of intra-operative transfusion (red cell concentrates [RCCs], fresh frozen plasma [FFP], platelets, and albumin), the use of an electroencephalogram (EEG) monitor, the duration of hospital stay, post-operative complications (hypoxia, delirium diagnosed by psychiatrists, and aspiration pneumonia), and 30-day survival after surgery. Hypoxia was defined as 'oxygen saturation (SpO2) under 95% with room air after surgery', and aspiration pneumonia defined as 'a newly diagnosed pneumonia after surgery with an episode of vomiting or aspiration'.…”

“…It is also known that worse frailty as evaluated by the ECOG-PS and mFI-5 and other assessment tools is associated with the surgical outcome in adult patients [9][10][11] . Especially among older patients, pre-and/or post-operative frailty or comorbidity are wellrecognized as predictive factors of mortality, in addition to the functional evaluation scales 12,13 .…”

“…Some perioperative management guidelines recommend using intensive patient monitoring and multimodal pain management for older patients 4,5 . Several studies have analyzed the pre-operative risk factors for mortality among older patients, using assessment tools including American Society of Anesthesiologists physical status (ASA-PS), the rate of pre-operative complications, the Charlson score 6 , the fall risk assessment 7 , the modified 5-item frailty index (mFI-5) 8 , and the Eastern Cooperative Oncology Group performance status (ECOG-PS) 9 . Frailty is a key factor in the peri-operative management of older patients, but when limited to patients aged >90, there has been no consensus regarding the optimal assessment methods or scales due to the absence of data.…”