Frailty worsens surgery outcomes in old patients

Frailty is associated with poor 1-year outcomes in elderly patients undergoing emergency general surgery (EGS), a recent study reports.

Researchers conducted a retrospective analysis of 468,459 elderly adults who underwent partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis or laparotomy. A validated claims-based frailty index was used to identify those who were prefrail, mildly frail and moderately-to-severely frail.

A total of 175,336 participants (37.4 percent) were prefrail, while 12.4 percent (n=58,056) and 3.6 percent (n=16,803) were mildly and moderately-to-severely frail, respectively; the remaining 218,264 were nonfrail. Fourteen percent of patients with any frailty received palliative care during index hospitalization.

The 30-day mortality was 15.7 percent (n=73,666), which grew to 24.7 percent (n=115,687) by day 180 and further to 30.4 percent (n=102,365) at 1 year. Crude mortality was highest among those with the most severe frailty.

Multivariable analysis confirmed that the risk of 30-day mortality was significantly elevated in those with prefrailty, mild and moderate-to-severe frailty, relative to the nonfrail comparators. These effects were consistent at 180 days and at 1 year. Notably, those at the highest levels of frailty were more than twice as likely to die at 1 year than nonfrail participants (hazard ratio, 2.30, 95 percent confidence intervals, 2.24–2.35).

Similarly, 1-year postdischarge outcomes, such as emergency department visits, rehospitalizations, stay in the intensive care and total hospital encounters, were all significantly worse in patients with any frailty. Greater severities of frailty resulted in higher risks across all outcomes.