Frailty Assessment Can Enhance Current Risk Prediction Tools in Emergency Laparotomy: A Retrospective Cohort Study.

Area of Science:

• Surgical Risk Stratification
• Geriatric Medicine
• Health Services Research

Background:

• Emergency laparotomy (EL) carries high mortality, particularly for frail, elderly patients.
• Current risk prediction tools like P-POSSUM and NELA RPT do not adequately incorporate patient frailty.
• Accurate risk assessment is vital for resource allocation, clinical decisions, and informed consent.

Purpose of the Study:

• To evaluate the performance of P-POSSUM and NELA Risk Prediction Tool (RPT).
• To determine if integrating the Clinical Frailty Scale (CFS) enhances these risk prediction models.
• To assess the impact of frailty on 30-day mortality after emergency laparotomy.

Main Methods:

• Retrospective single-center cohort study of NELA database cases (01.01.2018 - 15.06.2021).
• Analysis of P-POSSUM and NELA RPT performance.
• Modification of both tools by incorporating the Clinical Frailty Scale (CFS).

Main Results:

• Both P-POSSUM and NELA RPT demonstrated good discrimination, with slightly reduced performance in the elderly.
• Adding CFS significantly improved P-POSSUM and NELA RPT performance in elderly patients (AUC increased from 0.775 to 0.846 and 0.814 to 0.864, respectively).
• CFS was associated with 30-day mortality in patients >65 years, with a less marked effect in younger patients.

Conclusions:

• Combining P-POSSUM and NELA RPT with CFS significantly enhances risk prediction accuracy.
• Clinical Frailty Scale is a crucial factor in predicting 30-day mortality after emergency laparotomy.
• Frailty's impact on mortality is evident across all age groups, though more pronounced in the elderly.