Prediction of functional loss in emergency surgery is possible with a simple frailty screening tool

Abstract

Background Senior adults fear postoperative loss of independence the most, and this might represent an additional burden for families and society. The number of geriatric patients admitted to the emergency room requiring an urgent surgical treatment is rising, and the presence of frailty is the main risk factor for postoperative morbidity and functional decline. Frailty assessment in the busy emergency setting is challenging. The aim of this study is to verify the effectiveness of a very simple five-item frailty screening tool, the Flemish version of the Triage Risk Screening Tool (fTRST), in predicting functional loss after emergency surgery among senior adults who were found to be independent before surgery. Methods All consecutive individuals aged 70 years and older who were independent (activity of daily living (ADL) score ≥5) and were admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 were prospectively included in the study. On admission, individuals were screened using the fTRST and additional metrics such as the age-adjusted Charlson Comorbidity Index (CACI) and the ASA score. Thirty- and 90-day complications and postoperative decline in the ADL score where recorded. Regression analysis was performed to identify preoperative predictors of functional loss. Results Seventy-eight patients entered the study. Thirty-day mortality rate was 12.8% (10/78), and the 90-day overall mortality was 15.4% (12/78). One in every four patients (17/68) experienced a significant functional loss at 30-day follow-up. At 90-day follow-up, only 3/17 patients recovered, 2 patients died, and 12 remained permanently dependent. On the regression analysis, a statistically significant correlation with functional loss was found for fTRST, CACI, and age≥85 years old both at 30 and 90 days after surgery. fTRST≥2 showed the highest effectiveness in predicting functional loss at 90 days with AUC 72 and OR 6.93 (95% CI 1.71–28.05). The institutionalization rate with the need to discharge patients to a healthcare facility was 7.6% (5/66); all of them had a fTRST≥2. Conclusion fTRST is an easy and effective tool to predict the risk of a postoperative functional decline and nursing home admission in the emergency setting.

Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database

“…Clinicians provided in-hospital rehabilitation, especially for elderly patients, presumably considering the impaired activities of daily living after surgery. 7 , 8 Although rehabilitation could have aided short-term early mobilization, the current analysis with adjustment for preoperative comorbidities and activities of daily living demonstrated that age older than 65 years was substantially associated with poor long-term functional prognosis. Notably, the hazard ratio increased rapidly compared with that for mortality.…”

“…Impaired activity of daily living following surgery also is a serious concern among the elderly. 7 , 8 The impaired activity would result in poor quality of life; moreover, if a patient becomes bedridden, the condition is accompanied by several complications, such as bedsores, deep venous thrombosis, pneumonia, and urinary tract infections, deteriorating the optimal allocation of medical resources. 9 – 12 Because poor functional capacity will have a negative impact on survival, maintenance of function and independence has become one of the major principles of cancer management in the elderly.…”

“…However, although one study reported in-hospital postoperative activity in the elderly, long-term postoperative activity remains unclear. 8 …”

The Charlson Age Comorbidity Index Associated with Geriatric Patient’s Mortality after Emergency Surgery: A prospective National Multicenter Study

“…In elderly patients, the mortality rate in emergency surgery is about 15-30% and could increase up to 60% with comorbidities [13]. The latest study found 30-day mortality of emergency surgery in the elderly [14]. This surgical outcome is multiple times worse than elective surgery including in terms of morbidity and mortality, especially for those with multiple comorbidities [6].…”

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

“…The type of surgical intervention was categorized as either major or intermediate-minor. We defined major surgery as surgical interventions such as bowel resection, Hartmann’s surgery, or surgery for diffuse peritonitis and intermediate-minor surgery as cholecystectomy (excluding diffuse peritonitis), appendicectomy, dissection of adhesions, stoma creation without resection, hernia repair, diagnostic LS or OS [ 29 ].…”