Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study

Abstract

BackgroundFrailty has been associated with an increased risk of adverse postoperative outcomes in elderly patients. We examined the impact of preoperative frailty on loss of functional independence following emergency abdominal surgery in the elderly.MethodsThis prospective cohort study was performed at a tertiary hospital, enrolling patients 65 years of age and above who underwent emergency abdominal surgery from June 2016 to February 2018. Premorbid variables, perioperative characteristics and outcomes were collected. Two frailty measures were compared in this study—the Modified Fried’s Frailty Criteria (mFFC) and Modified Frailty Index-11 (mFI-11). Patients were followed-up for 1 year.ResultsA total of 109 patients were prospectively recruited. At baseline, 101 (92.7%) were functionally independent, of whom seven (6.9%) had loss of independence at 1 year; 28 (25.7%) and 81 (74.3%) patients were frail and non-frail (by mFFC) respectively. On univariate analysis, age, Charlson Comorbidity Index and frailty (mFFC) (univariate OR 13.00, 95% CI 2.21–76.63, p < 0.01) were significantly associated with loss of functional independence at 1 year. However, frailty, as assessed by mFI-11, showed a weaker correlation than mFFC (univariate OR 4.42, 95% CI 0.84–23.12, p = 0.06). On multivariable analysis, only premorbid frailty (by mFFC) remained statistically significant (OR 15.63, 95% CI 2.12–111.11, p < 0.01).ConclusionsThe mFFC is useful for frailty screening amongst elderly patients undergoing emergency abdominal surgery and is a predictor for loss of functional independence at 1 year. Including the risk of loss of functional independence in perioperative discussions with patients and caregivers is important for patient-centric emergency surgical care. Early recognition of this at-risk group could help with discharge planning and priority for post-discharge support should be considered.

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

“…Outcome 3McGuckin et al [26] 2018 **** *** Tan et al [27] 2019 **** * Parmar et al [28] 2019 **** ** *** Carter et al [29] 2020 **** ** *** Arteaga et al [30] 2020 **** *** Vilches-Moraga et al [31] 2020 *** * ***…”

“…Therefore, the results of this study can be widely applied to emergency general surgery patients ≥ 65 years. Another strength is that five of the six included studies were prospective cohorts by design [27][28][29][30][31], four of which were considered low risk of bias according to the NOS scale.…”

“…1). Six studies from five cohorts were included (five full studies and partial data from one study including colorectal and upper gastrointestinal surgery only) [26][27][28][29][30][31]. The main reason for the exclusion of full texts was if frailty was measured by alternative methods other than the Clinical Frailty Scale or Modified Frailty Index, or not measured at all.…”

“…Study patients were enrolled between June 2012 and April 2019. They were conducted in the United Kingdom [26,28,29,31], Singapore [27], and Spain [30]. Five of them reported frailty measured by the Clinical Frailty Scale [26,[28][29][30][31] and only one by the Modified Frailty Index [27].…”

“…They were conducted in the United Kingdom [26,28,29,31], Singapore [27], and Spain [30]. Five of them reported frailty measured by the Clinical Frailty Scale [26,[28][29][30][31] and only one by the Modified Frailty Index [27]. Inclusion criteria were 65 for four studies [26][27][28][29], and 70 and 75 for the two other studies [30,31].…”