The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Lorenzon, Laura; Costa, Gianluca; Massa, Giovanni; Frezza, Barbara; Stella, Francesco; Balducci, Genoveffa

doi:10.1007/s00595-016-1361-1

Cited by 21 publications

(14 citation statements)

References 23 publications

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“…A recent retrospective analysis of the NSQIP of approximately 230,000 patients who underwent surgery from 2012 to 2015 evaluated the relationship between age, frailty, and type of surgery: this study found an increased risk of mortality and morbidity among frail patients who underwent surgery (including “minor surgery”) [41]. Frailty scores in ACC surgical setting are currently under development after which external validation will be performed [32, 42, 43].…”

Section: Resultsmentioning

confidence: 99%

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

et al. 2019

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Background Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide. Aim The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population. Material and methods The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences. Results The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain. Discussion and conclusions The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.

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Section: Resultsmentioning

confidence: 99%

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

et al. 2019

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“…A retrospective study of elderly patients undergoing lung transplantation found no significant association of frailty with the duration of postoperative ventilator use or duration of stay in the intensive care unit; however, frailty was associated with a significantly greater risk of postoperative death [adjusted HR: 2.24] 24. In another study, preoperative surgical risk score of frail elderly patients undergoing emergency cholecystectomy was significantly greater than that of non-frail patients,25 which is consistent with the results of our study. Our research corroborates these findings and suggests that preoperative frailty assessment may confer an advantage in Chinese elderly patients undergoing major thoracic or abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

<p>Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery</p>

Han¹,

Li²,

Chen³

2019

CIA

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Purpose: To determine the association between frailty and postoperative complications in elderly Chinese patients and to determine whether addition of frailty assessment improves the predictive ability of the American Society of Anesthesiologists (ASA) score, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Estimation of Physiologic Ability and Surgical Stress (E-PASS) score. Patients and methods: A prospective cohort study was conducted in a tertiary hospital. Elderly patients undergoing major thoracic or abdominal surgery were included. Frailty phenotype and ASA, POSSUM, and E-PASS scores were assessed. Demographic, preoperative, and surgical variables were extracted from medical records. Primary outcome measure was in-hospital Clavien-Dindo ≥ grade II complications. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves were used to explore the predictive ability of frailty. Results: Prevalence of frailty was 26.12%. Significant differences were observed between the frail and non-frail groups with respect to age, Activities of Daily Living, Charlson Comorbidity Index, respiratory function, presence of malignancy, serum albumin, prealbumin, and hemoglobin levels ( P <0.05). ASA, POSSUM, and E-PASS scores were higher in the frail group. After adjusting for all covariates, frailty was significantly associated with postoperative complications in hospital [odds ratio: 16.59, 95% CI: 4.56–60.40, P <0.001]. The area under the curve (AUC) for frailty was 0.762 (95% CI: 0.703–0.814). The AUC for ASA, POSSUM, and E-PASS for prediction of complications was 0.751 (95% CI: 0.692–0.804), 0.762 (95% CI: 0.704–0.814), and 0.824 (95% CI: 0.771–0.870), respectively. Addition of frailty assessment increased the AUC to 0.858 (95% CI: 0.808–0.899), 0.842 (95% CI: 0.790–0.885), and 0.854 (95% CI: 0.803–0.896), respectively. Conclusion: Frailty is an effective predictor of postoperative complications in elderly Chinese patients undergoing major thoracic and abdominal surgery. Frailty assessment can improve the predictive ability of current surgical risk assessment tools. Frailty phenotype should be considered perioperatively. Frailty assessment could also expand the scope for nurses to evaluate patients for safety management.

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“…These latter components of elderly physiologic reserve have been independently verified to pose increased odds of postoperative mortality in elderly surgical cohorts and distinguish the mFI from other comorbid indexes [ 26 , 27 ]. Moreover, frailty is an important metric that is being increasingly used to predict postoperative outcomes in both our aging population [ 1 – 3 , 6 , 8 ] and emergency surgery [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Morbidity and Mortality following Open Emergent Colectomies

Congiusta

Palvannan

Merchant

2017

BioMed Research International

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Background Elderly and frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored. Objective The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery. Design Using the American College of Surgeons National Quality Improvement Program database, a validated modified frailty index was used, along with logistic regression, to assess the relationship between frailty and outcomes. Main Outcome Measures Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary). Results The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. There was a statistically significant increase in prevalence of all outcomes with increasing frailty. Limitations A causal relationship between frailty and complications cannot be established in a retrospective analysis. Also, extrapolation of our data to reflect outcomes beyond 30 days must be done with caution. Conclusions Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care setting.

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The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Abstract: Frailty syndrome significantly impacts the length of hospitalization in patients undergoing emergency cholecystectomy. Although the ORs were limited, the P-Possum value was independently associated with the outcome.

Cited by 21 publications

References 23 publications

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

<p>Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery</p>

The Impact of Frailty on Morbidity and Mortality following Open Emergent Colectomies

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