Abstract
Background
There is evolving evidence that pre-operative frailty predicts outcomes of older adults undergoing emergency laparotomy (EmLap). We assessed frailty scoring in an emergency surgical population that included patients of all ages and then compared to an established peri-operative prognostic score.
Methods
Data from the prospective Emergency Laparoscopic and Laparotomy Scottish Audit (ELLSA; November 2017-October 2018) was used. All adults over 18 were included. Frailty was measured using 7-point Clinical Frailty Score (CFS). Outcome measures: 30-day mortality, hospital length of stay (LOS), 30-day re-admission. Areas under the receiver-operating characteristic (ROC) curves were calculated for CFS (1-7) and compared to the National Emergency Laparotomy Audit (NELA) Score with Forest plots used to compare 30-day mortality across CFS and NELA categories.
Results
2246 patients [median age 65 years (IQR 51-75); female 51%] underwent EmLap (60% for colorectal pathology). 10.6% were frail pre-operatively (≥CFS 5). As CFS increased so did 30-day mortality (2.1% CFS1 to 25.3% CFS6&7; ꭓ278.2, p<0.001) and median LOS (10 days CFS1 to 20 days CFS6&7; p<0.001). Readmission rates did not differ significantly across CFS. ROC (95% CI) for mortality was 0.71 (0.65-0.77) for CFS and 0.84 (0.78-0.89) for NELA. Addition of CFS to NELA did not increase ROC value.
Conclusions
This study supports the prognostic role of frailty in the emergency surgical setting, finding increasing frailty to be associated with increased mortality and longer LOS in adults of all ages. Although NELA performed better, CFS remained predictive and has the advantage of being calculated pre-operatively to aid decision-making and treatment planning.
There is evolving evidence that pre-operative frailty predicts outcomes of older adults undergoing emergency laparotomy (EmLap). We assessed frailty scoring in an emergency surgical population that included patients of all ages and then compared to an established peri-operative prognostic score.
Methods
Data from the prospective Emergency Laparoscopic and Laparotomy Scottish Audit (ELLSA; November 2017-October 2018) was used. All adults over 18 were included. Frailty was measured using 7-point Clinical Frailty Score (CFS). Outcome measures: 30-day mortality, hospital length of stay (LOS), 30-day re-admission. Areas under the receiver-operating characteristic (ROC) curves were calculated for CFS (1-7) and compared to the National Emergency Laparotomy Audit (NELA) Score with Forest plots used to compare 30-day mortality across CFS and NELA categories.
Results
2246 patients [median age 65 years (IQR 51-75); female 51%] underwent EmLap (60% for colorectal pathology). 10.6% were frail pre-operatively (≥CFS 5). As CFS increased so did 30-day mortality (2.1% CFS1 to 25.3% CFS6&7; ꭓ278.2, p<0.001) and median LOS (10 days CFS1 to 20 days CFS6&7; p<0.001). Readmission rates did not differ significantly across CFS. ROC (95% CI) for mortality was 0.71 (0.65-0.77) for CFS and 0.84 (0.78-0.89) for NELA. Addition of CFS to NELA did not increase ROC value.
Conclusions
This study supports the prognostic role of frailty in the emergency surgical setting, finding increasing frailty to be associated with increased mortality and longer LOS in adults of all ages. Although NELA performed better, CFS remained predictive and has the advantage of being calculated pre-operatively to aid decision-making and treatment planning.
| Original language | English |
|---|---|
| Pages (from-to) | 782-789 |
| Number of pages | 8 |
| Journal | Colorectal Disease |
| Volume | 24 |
| Issue number | 6 |
| Early online date | 15 Mar 2022 |
| DOIs | |
| Publication status | Published - 1 Jun 2022 |
Bibliographical note
AcknowledgmentsWe wish to thank David McDonald, Jennifer Edwards and Neil Pekins of ELLSA for their support of this work. We also want to highlight the enthusiasm from all participating Scottish sites in supporting the ELLSA initiative.
Keywords
- emergency laparotomy
- frailty
- NELA score
- surgery