Frailty in Older Patients undergoing Emergency Laparotomy: Results from the U.K. observational Emergency Laparotomy and Frailty (ELF) Study.

on behalf of the ELF Study Group

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Abstract / Description of output

Objective This study aimed to document the prevalence of frailty in older adults undergoing emergency laparotomy (ELAP) and to explore relationships between frailty and post-operative morbidity and mortality.
Summary Background Data The majority of adults undergoing ELAP are older adults (≥65 years) that carry the highest mortality. Improved understanding is urgently needed to allow development of targeted interventions.
Methods An observational multi-centre (n=49) U.K. study was performed (March to June 2017). All older adults undergoing ELAP were included. Pre-operative frailty score was calculated using the progressive Clinical Frailty Score (CFS): 1 (very fit) to 7 (severely frail). Primary outcome measures were the prevalence of frailty (CFS 5-7) and its association to mortality at 90-days post-operative. Secondary outcomes included 30-day mortality and morbidity, length of critical care and overall hospital stay.
Results 937 older adults underwent ELAP: frailty was present in 20%. 90-day mortality was 19·5%. After age and sex adjustment, the risk of 90-day mortality was directly associated with frailty: CFS 5 aOR 3.18 (95%CI 1·24 to 8·14) and CFS 6/7 aOR 6·10 (95%CI 2·26 to 16·45) compared to CFS 1. Similar associations were found for 30-day mortality. Increasing frailty was also associated with: increased risk of complications, length of ICU and overall hospital stay.
Conclusion A fifth of older adults undergoing ELAP are frail. The presence of frailty is associated with greater risks of post-operative mortality and morbidity and is independent of age. Frailty scoring should be integrated into acute surgical assessment practice to aid decision-making and development of novel post-operative strategies.
Original languageEnglish
JournalAnnals of Surgery
DOIs
Publication statusPublished - 7 Jun 2019

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