Frailty in elderly patients with acute appendicitis.

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Acute Care

Background:

• Acute appendicitis in the elderly often presents with severe courses.
• Frailty is a known risk factor for adverse outcomes in older surgical patients.
• Limited data exists on frailty's impact specifically in elderly acute appendicitis cases.

Purpose of the Study:

• To investigate the association between frailty and outcomes in elderly patients undergoing surgery for acute appendicitis.
• To compare the efficacy and efficiency of two frailty assessment tools: the Hospital Frailty Risk Score (HFRS) and the modified Frailty Index (mFI).

Main Methods:

• A cohort of patients aged 65 and older with acute appendicitis was assessed using HFRS and mFI.
• Surgical outcomes including morbidity, mortality, intensive care unit (ICU) admissions, and length of stay were recorded.
• Data was collected from January 2015 to September 2020 across three hospitals.

Main Results:

• The mFI demonstrated superior applicability and significantly faster implementation (21.6s vs. 80.3s) compared to HFRS, while yielding comparable information.
• Frail patients exhibited significantly higher rates of mild and serious complications, increased ICU admissions, and nearly doubled length of stay.
• A substantial 31% of frail patients required institutional care post-discharge, and their mortality rate was significantly elevated at 17% versus less than 1% in non-frail patients.

Conclusions:

• Frailty is a significant predictor of poor outcomes in elderly patients with acute appendicitis.
• The mFI offers a more efficient and reliable method for assessing frailty in this demographic compared to HFRS.