[Emergency surgery in extremely frail patients]

When considering emergency surgery in extremely frail patients, decision-making should include the patient's own goals and chances of survival with maintained reasonable quality of life. Sweden has a very high proportion of patients undergoing surgery for hip fractures compared to other countries. Equivalent data for emergency abdominal surgery are unknown. Non-surgical treatment and focus on palliative care is more common in e.g. the Netherlands, from where research in the area is published. It is unknown how often patients are involved in discussions about operative or non-operative treatments, and to what extent factors other than survival are weighed into the decision. External validation of international prediction models for assessment of an individual's postoperative risk has so far been sparse in Sweden. There are scientifically evaluated models for structured discussions on transitioning to palliative care in the emergency surgical setting.