The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Abstract

Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

Validating administratively derived frailty scores for use in Veterans Health Administration emergency departments

“…Frailty scores that require patient interview or physical assessment can be burdensome for the ED clinician to administer and could delay care for a patient's presenting ED complaint. Furthermore, unlike other frailty measures that can be disease or specialty specific like the Carolina Frailty Index or the Emergency Surgery Frailty Index (specific for emergency surgery patients), the CAN score and the VA‐FI are broadly applicable, therefore providing a source of common ground among specialties for patients requiring multidisciplinary care 42,43 …”

“…Furthermore, unlike other frailty measures that can be disease or specialty specific like the Carolina Frailty Index or the Emergency Surgery Frailty Index (specific for emergency surgery patients), the CAN score and the VA-FI are broadly applicable, therefore providing a source of common ground among specialties for patients requiring multidisciplinary care. 42,43 In terms of application to VA EDs, we envision using the CAN score and the VA-FI in conjunction. The CAN score is readily available to all VA patients who receive primary care within the VA (which is the vast majority of the VA ED population).…”

An ensemble machine learning approach to predict postoperative mortality in older patients undergoing emergency surgery

“…Despite many attempts to evaluate and predict frailty in older patients in the last decades, a few frailty evaluation tools could be applied to older patients undergoing emergency surgery [ 16 , 21 ]. Since most older patients undergoing emergency surgery are vulnerable to surgical stress and are likely to develop postoperative complications, predicting or evaluating the preoperative frailty of these patients clinically is very important [ 22 ].…”

Metabolic Syndrome (MetS), Systemic Inflammatory Response Syndrome (SIRS), and Frailty: Is There any Room for Good Outcome in the Elderly Undergoing Emergency Surgery?

“…The frailty profile was investigated by the 5-modified Frailty Index (5-mFI) and the Emergency Surgery Frailty Index (EmSFI). According to other literature reports, a 5-mFI value ≥0.4 and an EmSFI value ≥4 were adopted as a cut-off to define a patient as frailty ( 31 , 32 ), but when performing statistical analysis, to simplify and make the results comparable with literature, only the 5-mFI ≥0.4 score was used for considering the frailty positive population. Postoperative complications have been reported and categorized according to the Clavien–Dindo (C–D) classification system by the study leader in each of the participating centers ( 33 ).…”