The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

Abstract

Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS.

Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest

“…[1][2][3] It was previously reported that a cross-reactive cephalosporin allergy occurs in 10% of penicillin-allergic patients. 4 This figure relates to studies prior to the 1980s, which demonstrated cross-reactivity between benzylpenicillin and first and second generation cephalosporins. However, early cephalosporin products may have been contaminated by Funding: None.…”

“…Frail patients have been found to have increased cardiopulmonary complications after emergency general surgery, increased mortality after major vascular surgery and increased mortality and decreased return to living at home after intensive care . Therefore, it seems likely that frailty would adversely affect recovery after in‐hospital cardiac arrest, but the association of frailty and outcome in this patient population has not previously been examined.…”

“…2 Frailty can also be identified from the accumulation of problems, such as low mood, impaired sleep, urinary incontinence, tremor, impaired coordination, poor standing posture, reduced muscle tone, irregular gait, falls, memory impairment and cognitive impairment. 3 Frail patients have been found to have increased cardiopulmonary complications after emergency general surgery, 4 increased mortality after major vascular surgery 5 and increased mortality and decreased return to living at home after intensive care. 6 Therefore, it seems likely that frailty would adversely affect recovery after in-hospital cardiac arrest, but the association of frailty and outcome in this patient population has not previously been examined.…”

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

“…In this acute setting, there is little time to medically optimize a patient with frailty before treatment. In single‐center studies within the United States, EGS patients with frailty experience a higher risk of in‐hospital complications, prolonged length of hospital and intensive care unit (ICU) stay, and 30‐day mortality . One prior study examined long‐term mortality among patients with frailty after EGS in Canada .…”

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

“…Several studies identify frailty as an independent risk factor for major morbidity, mortality, protracted length of stay, and institutional discharge in elective surgical care, but also increasingly in acute surgical care (Tolstrup et al 2017;Saxton and Velanovich 2011;Kim et al 2014;Kenig et al 2015;Makary et al 2010;Hewitt et al 2015), though with limited studies focusing solely on emergency laparotomy patients (Hamidi et al 2018;Joseph et al 2016;Lorenzon et al 2017;Mogal et al 2017;Akyar et al 2018;Seib et al 2018).…”