Six screening instruments for frailty in older patients qualified for emergency abdominal surgery

Kenig, Jakub; Żychiewicz, Beata; Olszewska, Urszula; Barczyński, Marcin; Nowak, Wojciech

doi:10.1016/j.archger.2015.06.018

Cited by 78 publications

(62 citation statements)

References 23 publications

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“…Twenty studies were of prospective design with sample sizes ranging from 30 to 450 [17–36], and three were of retrospective design [37–39], one of which contained a large sample size of nearly 13,000 participants [37]. Publications came from different countries, including USA [17, 18, 35, 37–39], UK [30, 32, 34, 36], Europe [19–28, 31], and Asia [29, 33]. The proportion of females ranged from 31 % [34] to 83 % [35].…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies measured frailty in cardiac surgery [17–24, 39], six in oncological surgery (predominantly focusing on colorectal cancer) [25–29, 37], three in general surgery [30, 31, 33], three in hip fracture surgery [35, 36, 38] and two in vascular surgery [32, 34]. Sixteen articles involved participants undergoing elective surgery [17–29, 33, 37, 39], five involved those undergoing acute surgery [30, 31, 35, 36, 38], while two included those undergoing both elective and acute surgery [32, 34].…”

Section: Resultsmentioning

confidence: 99%

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Frailty and post-operative outcomes in older surgical patients: a systematic review

et al. 2016

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BackgroundAs the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the ‘older old’ and ‘oldest old’ surgical patients.MethodsA systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument.ResultsTwenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty.ConclusionThere was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that different frailty tools are best suited for different acuity and type of surgical patients. The association between frailty and return to pre-morbid function, discharge destination, and quality of life after surgery warrants further research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Frailty and post-operative outcomes in older surgical patients: a systematic review

et al. 2016

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“…[8,9] Kenig, in a prospective study conducted with 184 patients aged ≥65 years, reported that it is possible to perform safe and efficient screening for frailty in older candidates for emergency surgery, and that Vulnerable Elders Survey-13, which simply asks questions about independent living, was the best screening instrument with highest sensitivity and negative predictive value for both postoperative mortality and morbidity. [10] Gomes et al reported that Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and morbidity (CR POSSUM) was the best predictor of surgical mortality and morbidity, that POSSUM and Portsmouth POSSUM scoring systems underestimated surgical mortality and morbidity, and that Colorectal Biochemical and Haematological Outcome Model overestimated surgical mortality. However, none of the scores in his retrospective study demonstrated sufficient discriminatory power to have clinical application value.…”

Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people. Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated. Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications. METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed. Data were collected in a dedicated database. Statistical analysis was conducted using IBM software SPSS 22 (IBM Corp., Armonk, NY, USA); statistical significance was set at p=0.05. RESULTS: In the period of study,19 patients aged over 90 underwent surgery in emergency department for complicated CRC. Of the total, 52.63% were female, with sex ratio F:M of 1.11:1. Mean age was 92.52 years (range: 90-97 years; SD 1.49). Preoperative assessment of surgical risk was made using American Society of Anesthesiologists (ASA) score. There was no statistically significant difference in terms of in-hospital mortality between patients with ASA score ≤ 3 and patients with an ASA score >3. Primary anastomosis was performed in 6 of 19 patients (31.57%), all of whom had right-side colon cancer. Diverting stoma was created for 12 of 19 patients (63.15%). There was a statistically significant difference in incidence of postoperative complications between patients with right-side colon cancer and patients with left-side colon cancer (p=0.0498). Mean length of hospital stay was 12.78 days (range: 2-31 days; SD 6.31). In-hospital mortality rate was 21.05% (n=4). At follow up, overall survival was 47.36% (n=9). CONCLUSION: Elective surgery is the best way to manage CRC in all patients affected. Emergency surgery for CRC complications in patients over 90 is feasible with careful preoperative selection and evaluation of the patient. One-stage surgery is the best choice, in selected patients. Two-and three-stage surgery is indicated in case of peritonitis, for frail patients, for hemodynamically unstable patients. If there is high risk of anastomotic leakage, decompressive stoma is suggested as bridge to elective surgery, and in advanced neoplastic disease, as palliative procedure. In emergency setting, diverting stoma is a good surgical option in nonagenarian patients to decrease surgical risk, morbidity, and mortality; however, clinical randomized controlled trials are necessary to confirm this.

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“…Core to the associated poor outcomes is the reduced physiological reserve and limited response to any minor or major stressor that comes with age [40] and which is summarized in the concept of "frailty" [41]. While frailty can be readily defined [41,42], it is difficult to measure in the emergency setting, although attempted by several recent approximated measures [43][44][45][46]. In particular, patients with IAIs and pre-existing malignant disease have a particular high risk for a poor outcome [47,48].…”

Section: Statementmentioning

confidence: 99%

Management of Intra-Abdominal Infections

Moore

2016

Common Problems in Acute Care Surgery

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This paper reports on the consensus conference on the management of intra-abdominal infections (IAIs) which was held on July 23, 2016, in Dublin, Ireland, as a part of the annual World Society of Emergency Surgery (WSES) meeting. This document covers all aspects of the management of IAIs. The Grading of Recommendations Assessment, Development and Evaluation recommendation is used, and this document represents the executive summary of the consensus conference findings.

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Six screening instruments for frailty in older patients qualified for emergency abdominal surgery

Cited by 78 publications

References 23 publications

Frailty and post-operative outcomes in older surgical patients: a systematic review

Frailty and post-operative outcomes in older surgical patients: a systematic review

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Management of Intra-Abdominal Infections

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