Faculty Collaboration Database

Impact of Patient Frailty on Morbidity and Mortality after Common Emergency General Surgery Operations. J Surg Res 2020 Mar;247:95-102

Date

12/04/2019

Pubmed ID

31787316

DOI

10.1016/j.jss.2019.10.038

Scopus ID

2-s2.0-85075853085 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

BACKGROUND: Frailty has been increasingly recognized as a modifiable risk factor prior to elective general surgery. There is limited evidence regarding the association of frailty with perioperative outcomes after specific emergency general surgery procedures.

MATERIAL AND METHODS: A retrospective cohort study of 57,173 patients older than 40 y of age from 2010 to 2014 American College of Surgeons National Surgical Quality Improvement Program underwent appendectomy, cholecystectomy, large bowel resection, small bowel resection, or nonbowel resection (lysis of adhesion, ileostomy creation) on an emergent basis. Preoperative modified frailty index (mFI) was determined for each patient and was used in a multivariable logistic regression to determine the association with perioperative morbidity, mortality, and discharge destination.

RESULTS: A total of 57,173 patients (46% men, mean [SD] age 60 [13] y) underwent an emergency appendectomy (n = 26,067), cholecystectomy (n = 8138), large bowel resection (n = 12,107), small bowel resection (n = 6503), or nonbowel resection (n = 4358). Among them, 14,300 (25.0%) experienced any perioperative complication, and 12,668 (22.2%) experienced a serious complication with an overall 30-d mortality of 5.1%. Highly frail patients had a 30-d mortality of 19.0% across all five operations. In multivariable analysis, mFI was associated with any complication and 30-d mortality in a step-wise fashion for each emergency operation. Intermediate and high mFI were also inversely associated with discharge home for each operation.

CONCLUSIONS: Frailty is associated with increased perioperative morbidity and mortality in common emergency general surgery operations. Frailty should be assessed by surgeons to inform decisions on operative intervention and to inform patients/families on expected outcomes.

Author List

Murphy PB, Savage SA, Zarzaur BL

Author

Patrick Murphy MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Aged, 80 and over
Clinical Decision-Making
Comorbidity
Datasets as Topic
Digestive System Surgical Procedures
Emergency Treatment
Female
Frail Elderly
Frailty
Geriatric Assessment
Humans
Male
Middle Aged
Patient Selection
Postoperative Complications
Retrospective Studies
Risk Factors
Treatment Outcome