Emergent Laparotomy for Blunt Trauma: Operating on Frail Older Adults Goes Beyond the Operating Room

Frailty is prevalent among geriatric patients and is a risk factor for worse outcomes in this population. The aim of this study is to provide setting-specific evidence by comparing outcomes of emergent laparotomy between frail and nonfrail geriatric blunt trauma patients.

A 5-y (2017-2021) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program was performed. Older adult (age ≥65 y) blunt trauma patients who underwent emergent laparotomy were included and stratified using the 11-factor modified frailty index into frail (F) and nonfrail (NF) groups. Primary outcome was in-hospital mortality. Secondary outcomes were hospital and intensive care unit length of stay (LOS), and major complications (cardiac arrest, myocardial infarction, acute respiratory distress syndrome, acute kidney injury, deep venous thrombosis, pulmonary embolism, stroke, sepsis, surgical site infection, and catheter-associated urinary tract infection). Univariate and multivariable regression analyses, adjusting for potential confounding factors, were performed.

We identified a total of 1655 geriatric blunt trauma patients who underwent laparotomy (F: 273, NF: 1382). The mean age was 74 (7) y and 66% were male. The median injury severity score was 14 [9-25] and the median time to laparotomy was 112 [52-223] min. There was no significant difference in terms of injury characteristics and time to laparotomy between F and NF groups. On univariate analysis, there was no difference in terms of mortality (P = 0.161), intensive care unit LOS (P = 0.204), and major complications (P = 0.969); however, F group had significantly longer median hospital LOS (F: 10 [5-15] versus NF: 8 [2-14], P = 0.001). On multivariable regression analysis, F group was independently associated with higher odds of mortality (adjusted odds ratio: 1.665, 95% confidence interval [1.194-2.321], P = 0.003) and longer hospital LOS (β: +2.131, 95% confidence interval [+0.492 to +3.771], P = 0.011).

In older adults undergoing emergent laparotomy after blunt trauma, frailty identifies patients at increased risk of in-hospital mortality and prolonged length of stay; incorporating frailty assessment at presentation can guide perioperative counseling and resource planning.