Frailty predicts morbidity, mortality in elderly patients needing emergency colorectal surgery

Frailty is a predictor of morbidity, mortality, and loss of independence in elderly patients needing emergency colorectal surgery, suggests a recent study.

The investigators identified elderly patients aged ≥65 years who underwent emergency colorectal resection between 2012 and 2016 from the American College of Surgeons National Surgical Quality Improvement Program population database. They also calculated the five-item modified frailty index (mFI-5) and stratified patients into groups 0, 1, or 2+.

Outcome measures were the prevalence of frailty and its impact on 30-day postoperative morbidity, mortality, reoperation, length of hospital stay (LOS), discharge destination, and readmission.

Of the 10,025 patients (median age, 75 years) included in the study, 41.8 percent were men. Majority of the patients (87.7 percent) had an American Society of Anaesthesiologists fitness grade of III or greater, and 3,129 (31.2 percent) were frail (mFI-5 group 2+).

One-third of patients had major morbidity, while 15.9 percent succumbed to postoperative death. Fifty-two percent of patients had a prolonged hospital stay and 11 percent were readmitted. Majority of the patients (88.0 percent) lived independently prior to surgery, but only 45.4 percent were discharged home directly.

Frailty (mFI‐5 2+) was associated with mortality, overall and major morbidity, reoperation, prolonged LOS, discharge to an institution, and readmission, but frailty was independent of sex.

“Frailty is associated with advancing age and may result in adverse postoperative outcomes,” the investigators said. “A suspected growing elderly population needing emergency colorectal surgery stimulated this study of the prevalence and impact of frailty.”