Impact of frailty in surgical emergencies. A comparison of four frailty scales

Arteaga, Alejandro Sánchez; Aguilar, L Tallón; González, José Tinoco; Boza, Ana Senent; Muñoz‐Cruzado, Virginia Durán; Ciuró, Felipe Pareja; Ruiz, J Padillo

doi:10.1007/s00068-020-01314-3

Cited by 17 publications

(49 citation statements)

References 23 publications

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“…The second one reported an unadjusted OR of 2.71 [28]. There was also an increase in [30]. The pooled OR, using random-effect models, was 2.91 (95% CI 2.00, 4.23).…”

Section: Primary Outcomementioning

confidence: 91%

“…1). Six studies from five cohorts were included (five full studies and partial data from one study including colorectal and upper gastrointestinal surgery only) [26][27][28][29][30][31]. The main reason for the exclusion of full texts was if frailty was measured by alternative methods other than the Clinical Frailty Scale or Modified Frailty Index, or not measured at all.…”

Section: Study Selectionmentioning

confidence: 99%

“…Study patients were enrolled between June 2012 and April 2019. They were conducted in the United Kingdom [26,28,29,31], Singapore [27], and Spain [30]. Five of them reported frailty measured by the Clinical Frailty Scale [26,[28][29][30][31] and only one by the Modified Frailty Index [27].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…They were conducted in the United Kingdom [26,28,29,31], Singapore [27], and Spain [30]. Five of them reported frailty measured by the Clinical Frailty Scale [26,[28][29][30][31] and only one by the Modified Frailty Index [27]. Inclusion criteria were 65 for four studies [26][27][28][29], and 70 and 75 for the two other studies [30,31].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Fehlmann

Patel

McCallum

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The purpose of this review was to determine the association between frailty and mortality among adults ≥ 65 years old undergoing emergency general surgery (EGS). Methods This systematic review followed the PRISMA guidelines (CRD42020172482 on PROSPERO). A search in MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews was conducted from inception to March 5, 2020. Studies with patients ≥ 65 years undergoing EGS were included. The primary exposure was frailty, measured using the Clinical Frailty Scale or the Modified Frailty Index. The primary outcome was 30-day mortality. Secondary outcomes were 90-day and 1-year mortality, length of stay, complications, change in level of care at discharge, and loss of independence. Two independent reviewers screened articles and extracted data. Risk of bias was assessed according to the Newcastle–Ottawa Scale and quality of evidence was assessed using the GRADE approach. A meta-analysis was performed for 30-day mortality using a random-effects model. Results Our search yielded 847 articles and six cohort studies were included in the systematic review. There were 1289 patients, 283 being frail. The pooled OR from meta-analysis for frail compared to non-frail patients was 2.91 (95% CI 2.00, 4.23) for 30-day mortality. Frailty was associated with increased odds of all secondary outcomes. Conclusion Frailty is significantly associated with worse outcomes after emergency general surgery in adults ≥ 65 years of age. The Clinical Frailty Scale could be used to improve preoperative risk assessment for patients and shared decision-making between patients and healthcare providers. Registration number CRD42020172482 (PROSPERO).

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“…The second one reported an unadjusted OR of 2.71 [28]. There was also an increase in [30]. The pooled OR, using random-effect models, was 2.91 (95% CI 2.00, 4.23).…”

Section: Primary Outcomementioning

confidence: 91%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Fehlmann

Patel

McCallum

et al. 2021

Eur J Trauma Emerg Surg

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“…Frailty Scale score, 7,8 type of pathology, and surgery ( Table 1 and Table 2). Matching was satisfactory, as the only differences at baseline were strictly associated with COVID-19, causing sepsis and/or respiratory insufficiency requiring intubation in 3 patients during the preoperative period (Table 1).…”

Section: Figure Classification Tree For Complications and Their Assomentioning

confidence: 99%

Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy

et al. 2020

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IMPORTANCE There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery. OBJECTIVE To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties. DESIGN, SETTING, AND PARTICIPANTS This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score. EXPOSURES Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase-polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations. MAIN OUTCOMES AND MEASURES The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors. RESULTS Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]; mean [SD] age, 76.6 [14.4] years), 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR, 4.98; 95% CI, 1.81-16.07); pulmonary complications were the most common (OR, 35.62; 95% CI, 9.34-205.55), but thrombotic complications were also significantly associated with COVID-19 (OR, 13.2; 95% CI, 1.48-ϱ). Different models (cumulative link model and classification tree) identified COVID-19 as the main variable associated with complications. CONCLUSIONS AND RELEVANCE In this matched cohort study, surgical mortality and complications were higher in patients with COVID-19 compared with patients without COVID-19. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.

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