Increasing Frailty in Geriatric Emergency General Surgery: A Cause for Concern.

Autor: Kenawy DM; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: dahlia.kenawy@osumc.edu., Renshaw SM; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH., George E; College of Medicine, The Ohio State University, Columbus, OH., Malik AT; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH., Collins CE; Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2021 Oct; Vol. 266, pp. 320-327. Date of Electronic Publication: 2021 May 27.
DOI: 10.1016/j.jss.2021.04.010
Abstrakt: Background: Emergency general surgery (EGS) presents a challenge for frail, geriatric individuals who often have extensive comorbidities affecting postoperative recovery. Previous studies have shown an association between increasing frailty and adverse outcomes following elective and EGS; no study has explored the same for the geriatric patient population using the modified 5-item frailty index (mFI-5) score.
Materials and Methods: A retrospective cohort study was performed using the 2012-2017 American College of Surgeons - National Surgical Quality Improvement Program database to identify geriatric patients (≥65 years) undergoing EGS procedures within 48 h of admission. The previously validated mFI-5 score was used to assess preoperative frailty. The study cohort was divided into four groups: mFI-5 = 0, mFI-5 = 1, mFI-5 = 2, and mFI-5 ≥ 3; the impact of increasing mFI-5 score on failure-to-rescue (FTR), 30-day complications, readmissions, reoperations, and mortality was assessed.
Results: A total of 47,216 patients were included: 27.4% with mFI-5 = 0, 45% with mFI-5 = 1, 22.1% with mFI-5 = 2, and 5.5% with mFI-5 ≥ 3. Following multivariate analyses, increasing mFI-5 score was associated with higher odds of FTR (mFI-5 = 1: odds ratio (OR) 1.48, p=0.003; mFI-5 = 2: OR 2.66, p <0.001; mFI-5 ≥ 3: OR 3.97, p <0.001), 30-day complications (mFI-5 = 1: OR 1.46, p <0.001; mFI-5 = 2: OR 2.48, p <0.001; mFI-5≥3: OR 5.01, p <0.001), reoperation (mFI-5 = 1: OR 1.42, p = 0.020; mFI-5 = 2: OR 1.70, p = 0.021; mFI-5 ≥ 3: OR 2.18, p = 0.009) and all-cause mortality (mFI-5 = 1: OR 1.49, p=0.001; mFI-5 = 2: OR 2.67, p <0.001; mFI-5 ≥ 3: 3.96, p <0.001).
Conclusions: Increasing frailty in geriatric EGS patients is associated with significantly higher rates of FTR, 30-day complications, reoperations, and all-cause mortality. The mFI-5 score can be used to assess frailty and better anticipate the postoperative course of vulnerable geriatric patients.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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