This study aimed to document the prevalence of frailty
in older adults undergoing emergency laparotomy
and to explore relationships between frailty
and postoperative morbidity
Summary Background Data:
The majority of adults undergoing emergency laparotomy
are older adults (≥65 y) that carry the highest mortality
. Improved understanding is urgently needed to allow development of targeted interventions.
An observational multicenter (n=49) UK study was performed (March–June 2017). All older adults undergoing emergency laparotomy
were included. Preoperative frailty
score was calculated using the progressive Clinical Frailty
Score (CFS): 1 (very fit) to 7 (severely frail). Primary outcome measures were the prevalence of frailty
(CFS 5–7) and its association to mortality
at 90 days postoperative. Secondary outcomes included 30-day mortality
, length of critical care, and overall hospital stay.
A total of 937 older adults underwent emergency laparotomy
was present in 20%. Ninety-day mortality
was 19.5%. After age and sex adjustment, the risk of 90-day mortality
was directly associated with frailty
: CFS 5 adjusted odds ratio (aOR) 3.18 [95% confidence interval (CI), 1.24–8.14] and CFS 6/7 aOR 6·10 (95% CI, 2.26–16.45) compared with CFS 1. Similar associations were found for 30-day mortality
. Increasing frailty
was also associated with increased risk of complications, length of Intensive Care Unit, and overall hospital stay.
A fifth of older adults undergoing emergency laparotomy
are frail. The presence of frailty
is associated with greater risks of postoperative mortality
and is independent of age. Frailty
scoring should be integrated into acute surgical assessment practice to aid decision-making and development of novel postoperative strategies.