Long-term influence of frailty in elderly patients after surgical emergencies

Arteaga, Alejandro Sánchez; González, José Tinoco; Aguilar, L Tallón; Díaz, Gregorio Anguiano; Jiménez-Rodríguez, Rosa M; Liarde, Ana Rovira; Ciuró, Felipe Pareja; Ruiz, J Padillo

doi:10.1007/s00068-021-01818-6

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…A total of 18 studies with 4479 participants [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] were included after screening 7800 citations and 85 fulltext articles (Figure 1). An additional 4 studies were found to match our inclusion and exclusion criteria [39][40][41][42] ; however, they were missing necessary data for our analysis (ie, percent frail) [39][40][41] or used the same population as a previously published study. 42 Authors were contacted for additional data, and studies were excluded if authors did not respond or provide the additional data.…”

Section: Resultsmentioning

confidence: 99%

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

Gong

Qian

Riazi

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Several frailty screening tools have been shown to predict mortality and complications after surgery. However, these tools were developed for in-person evaluation and cannot be used during virtual assessments before surgery. The FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale is a brief assessment that can potentially be conducted virtually or self-administered, but its association with postoperative outcomes in older surgical patients is unknown. The objective of this systematic review and meta-analysis (SRMA) was to determine whether the FRAIL scale is associated with mortality and postoperative outcomes in older surgical patients.

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Section: Resultsmentioning

confidence: 99%

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

Gong

Qian

Riazi

et al. 2022

Anesthesia &Amp; Analgesia

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“…Murphy et al and Sánchez Arteaga et al evaluated different emergency general surgery operations and found similar results [ 14 , 15 ]. Other studies have shown that frailty is a risk factor for, inter alia, morbidity and mortality [ 16 – 19 ]. However, either unreported or playing only a subordinate role in these studies, appendicitis has yet to be fully addressed.…”

Section: Introductionmentioning

confidence: 99%

Frailty in elderly patients with acute appendicitis

Reinisch¹,

Reichert

Meva

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Acute appendicitis in the elderly is becoming increasingly recognized for its often severe course. For various elective and urgent operations in older patients, frailty is a risk factor for poor outcomes. However, there is a lack of data on frailty in elderly patients with acute appendicitis. Methods Patients over 65 years old who underwent surgery for acute appendicitis in three hospitals between January 2015 and September 2020 were assessed with the Hospital Frailty Risk Score (HFRS) and the modified Frailty Index (mFI). Outcomes of interest, including morbidity, mortality, and length of stay, were recorded. Results While frailty can be measured with both tests, the mFI has better applicability and takes significantly less time to implement compared to the HFRS (21.6 s vs. 80.3 s, p < 0.0001) while providing the same information value. Patients who exhibited frailty according to either assessment had a significantly higher rate of milder (OR 5.85/2.87, p < 0.0001/0.009) and serious (OR 4.92/3.61, p < 0.011/0.029) complications, more admissions to the intensive care unit (OR 5.16/7.36, p < 0.0001), and an almost doubled length of stay (12.7 days vs. 6.6 days, p < 0.005). Up to 31% of these patients required institutional care after discharge, which is significantly more than those without frailty (p < 0.0001). Furthermore, the mortality rate in frail patients was significantly elevated to 17%, compared to less than 1% in non-frail patients (p = 0.018). Conclusion In elderly patients, frailty is a significant risk factor for negative outcomes. Frailty can be assessed more quickly and reliably with the mFI compared to the HFRS.

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“…A total of 202,817 patients from the TR-DGU were checked for eligibility. The median hospital length of stay was 18 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] days. A total of 6,335 deceased (median length of stay 2[1-6] days) were excluded from further analysis just as 1,441 deceased (LOS: 9 [6-13] days).…”

Section: Resultsmentioning

confidence: 99%

“…Here, the Injury Severity Score (ISS), the injury pattern, the occurrence of complications, and the presence of pre-existing conditions is assumed to increase resource use and length of stay on Intensive Care Units (ICU) as well as the overall in-patient stay [11,12]. Due to the numerous concomitant circumstances complicating treatment in the elderly, one might assume that especially severely injured geriatric patients are more likely to undergo a complicated long-term stay in intensive care and prolonged overall hospitalization [13]. Especially in the complex treatment of severely injured elderly patients, consequently longer courses seem likely to occur and cause excessive resource consumption and high costs.…”

Section: Introductionmentioning

confidence: 99%

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly

Störmann,

Hörauf,

Sturm

et al. 2024

Preprint

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Methods: Due to demographic change, the number of polytraumatized geriatric patients (> 64 years) is expected to further increase in the coming years. In addition to the particularities of the accident and the associated injury patterns, prolonged inpatient stays are regularly observed in this group. The aim of the evaluation is to identify further factors that cause prolonged inpatient stays. A study of the data from the TraumaRegister DGU® from 2016-2020 was performed. Inclusion criteria were an age of over 64 years, intensive care treatment in the GAS-region, and an Injury Severity Score (ISS) of at least 16 points. All patients who were above the 80th percentile for the average length of stay or average intensive care stay of the study population were defined as so-called long-stay patients. This resulted in a prolonged inpatient stay of > 25 days and an intensive care stay of > 13 days. Among other, the influence of the cause of the accident, injury patterns according to body regions, the occurrence of complications, and the influence of numerous clinical parameters were examined. Results: A total of 23,026 patients with a mean age of 76.6 years and a mean ISS of 24 points were included. Mean ICU length of stay was 11 +/- 12.9 days (regular length of stay: 3.9 +/- 3.1d vs. prolonged length of stay: 12.8 +/- 5.7d) and mean inpatient stay was 22.5 +/- 18.9 days (regular length of stay: 20.7 +/- 15d vs. 35.7 +/- 22.3d). A total of n=6,447 patients met the criteria for a prolonged length of stay. Among these, patients had one more diagnosis on average (4.6 vs. 5.8 diagnoses) and had a higher ISS (21.8 +/- 6 pts. vs. 26.9 +/- 9.5 pts.) Independent risk factors for prolonged length of stay were intubation duration greater than 6 days (30-fold increased risk), occurrence of sepsis (4x), attempted suicide (3x), presence of extremity injury (2.3x), occurrence of a thromboembolic event (2.7x), and administration of red blood cell concentrates in the resuscitation room (1.9x). Conclusions: The present analysis identified numerous independent risk factors for significantly prolonged hospitalization of the geriatric polytraumatized patient, which should be given increased attention during treatment. In particular, the need for a smooth transition to psychiatric follow-up treatment or patient-adapted rehabilitative care for geriatric patients with prolonged immobility after extremity injuries is emphasized by these results.

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Long-term influence of frailty in elderly patients after surgical emergencies

Cited by 7 publications

References 24 publications

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

Frailty in elderly patients with acute appendicitis

Extremity fractures, attempted suicide, blood transfusion and thromboembolic events are independent risk factors for a prolonged hospital stay in severely injured elderly

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