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Frailty impacts outcomes for all older adult age groups in emergency laparotomy
Jefferson A Proaño-Zamudio1, Yasmin Arda1, Teresia M Perkins1
1Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA.
Background:
The quantitative effect of frailty on post-operative complications in older adults undergoing surgical emergencies is not well understood.
Methods:
The 2013-2019ACS-NSQIP database was used to identify emergency laparotomy patients≥65 years. Frailty was measured using the modified-frailty-index-5 factors (mFI-5). We examined 30-day mortality, discharge to home, post-operative complications and unplanned readmissions. Multivariable logistic regression examined the association between frailty and outcomes.
Results:
52,356 patients were included. The median age was 76(70-82) years. Most patients (68 %) had an mFI-5 score between 0.2 and 0.5. Higher frailty index was associated with higher mortality and shorter length of survival (log-rank p < 0.001). On multivariable analysis, a higher frailty index was associated with increased mortality, pneumonia, urinary tract infection, respiratory failure, acute kidney injury, and readmission in a linear fashion.
Conclusion:
Increasing levels of frailty not only increase the risk of adverse post-operative outcomes, but also increase the risk of further functional loss and deterioration after discharge.
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