Increasing Frailty in Geriatric Emergency General Surgery: A Cause for Concern

Area of Science:

• Geriatric Surgery
• Surgical Outcomes
• Frailty Assessment

Background:

• Emergency general surgery (EGS) poses significant challenges for frail geriatric patients with comorbidities.
• Previous research links frailty to adverse outcomes, but specific analysis using the modified 5-item frailty index (mFI-5) in geriatric EGS patients is lacking.

Purpose of the Study:

• To evaluate the association between preoperative frailty, assessed by the mFI-5 score, and postoperative outcomes in geriatric patients undergoing EGS.
• To determine if increasing mFI-5 scores correlate with higher rates of failure-to-rescue (FTR), 30-day complications, readmissions, reoperations, and mortality.

Main Methods:

• Retrospective cohort study utilizing the 2012-2017 American College of Surgeons - National Surgical Quality Improvement Program database.
• Inclusion of geriatric patients (≥65 years) undergoing EGS within 48 hours of admission.
• Stratification of patients into four groups based on mFI-5 scores (0, 1, 2, and ≥3) to assess outcomes including FTR, 30-day complications, readmissions, reoperations, and mortality.

Main Results:

• A total of 47,216 patients were analyzed.
• Increasing mFI-5 scores were significantly associated with higher odds of FTR (OR 3.97 for mFI-5 ≥ 3), 30-day complications (OR 5.01 for mFI-5 ≥ 3), reoperation (OR 2.18 for mFI-5 ≥ 3), and all-cause mortality (OR 3.96 for mFI-5 ≥ 3).

Conclusions:

• Elevated frailty, as measured by the mFI-5 score, is a strong predictor of adverse outcomes in geriatric patients undergoing EGS.
• The mFI-5 score is a valuable tool for assessing frailty and anticipating postoperative trajectories in vulnerable elderly surgical patients.