Frailty predicts mortality in all emergency surgical admissions regardless of age

An observational study

J. Hewitt (Corresponding Author), B. Carter, K. McCarthy, L. Pearce, J. Law, F. V. Wilson, H. S. Tay, C. McCormack, M. J Stechman, S. J. Moug, P. K. Myint

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background
frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.

Methods
a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.

Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.

Results
the cohort included 2,279 patients (median age 54 years [IQR 36–72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40’s to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61–2.01) supporting a linear dose–response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.

Conclusions
worsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.
Original languageEnglish
Pages (from-to)388-394
Number of pages7
JournalAge and Ageing
Volume48
Issue number3
Early online date19 Feb 2019
DOIs
Publication statusPublished - May 2019

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Observational Studies
Emergencies
Mortality
Length of Stay
Secondary Care
Cohort Studies
Age Groups
Prospective Studies

Keywords

  • frailty
  • mortality
  • emergency surgical admissions
  • all ages
  • older people

Cite this

Frailty predicts mortality in all emergency surgical admissions regardless of age : An observational study. / Hewitt, J. (Corresponding Author); Carter, B.; McCarthy, K.; Pearce, L.; Law, J.; Wilson, F. V.; Tay, H. S.; McCormack, C.; Stechman, M. J; Moug, S. J.; Myint, P. K.

In: Age and Ageing, Vol. 48, No. 3, 05.2019, p. 388-394.

Research output: Contribution to journalArticle

Hewitt, J, Carter, B, McCarthy, K, Pearce, L, Law, J, Wilson, FV, Tay, HS, McCormack, C, Stechman, MJ, Moug, SJ & Myint, PK 2019, 'Frailty predicts mortality in all emergency surgical admissions regardless of age: An observational study', Age and Ageing, vol. 48, no. 3, pp. 388-394. https://doi.org/10.1093/ageing/afy217
Hewitt, J. ; Carter, B. ; McCarthy, K. ; Pearce, L. ; Law, J. ; Wilson, F. V. ; Tay, H. S. ; McCormack, C. ; Stechman, M. J ; Moug, S. J. ; Myint, P. K. / Frailty predicts mortality in all emergency surgical admissions regardless of age : An observational study. In: Age and Ageing. 2019 ; Vol. 48, No. 3. pp. 388-394.
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title = "Frailty predicts mortality in all emergency surgical admissions regardless of age: An observational study",
abstract = "Backgroundfrail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.Methodsa multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.Resultsthe cohort included 2,279 patients (median age 54 years [IQR 36–72]; 56{\%} female). Frailty was documented in patients of all ages: 1{\%} in the under 40’s to 45{\%} of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80{\%} increase in mortality at Day 90 (OR 1.80, 95{\%} CI: 1.61–2.01) supporting a linear dose–response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.Conclusionsworsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.",
keywords = "frailty, mortality, emergency surgical admissions, all ages, older people",
author = "J. Hewitt and B. Carter and K. McCarthy and L. Pearce and J. Law and Wilson, {F. V.} and Tay, {H. S.} and C. McCormack and Stechman, {M. J} and Moug, {S. J.} and Myint, {P. K.}",
note = "Acknowledgements: Cardiff and Vale University Health Board: Aimee Browning, Svetlana Kulikouskaya, Rebecca Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman and Nurulaida Mohd Darus. North Bristol NHS Trust: Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell and Eng Hean Teh. Royal Alexandra Hospital: Adam Tay and Nurwasimah Haj Asnan. NHS Grampian: Matthew Greig, Vincent Quan. Central Manchester University Hospitals: Elizabeth Norr. Declaration of Conflict of Interest None. Declaration of Sources of Funding: We acknowledge the support of the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (B.C.).",
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TY - JOUR

T1 - Frailty predicts mortality in all emergency surgical admissions regardless of age

T2 - An observational study

AU - Hewitt, J.

AU - Carter, B.

AU - McCarthy, K.

AU - Pearce, L.

AU - Law, J.

AU - Wilson, F. V.

AU - Tay, H. S.

AU - McCormack, C.

AU - Stechman, M. J

AU - Moug, S. J.

AU - Myint, P. K.

N1 - Acknowledgements: Cardiff and Vale University Health Board: Aimee Browning, Svetlana Kulikouskaya, Rebecca Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman and Nurulaida Mohd Darus. North Bristol NHS Trust: Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell and Eng Hean Teh. Royal Alexandra Hospital: Adam Tay and Nurwasimah Haj Asnan. NHS Grampian: Matthew Greig, Vincent Quan. Central Manchester University Hospitals: Elizabeth Norr. Declaration of Conflict of Interest None. Declaration of Sources of Funding: We acknowledge the support of the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (B.C.).

PY - 2019/5

Y1 - 2019/5

N2 - Backgroundfrail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.Methodsa multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.Resultsthe cohort included 2,279 patients (median age 54 years [IQR 36–72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40’s to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61–2.01) supporting a linear dose–response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.Conclusionsworsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.

AB - Backgroundfrail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages.Methodsa multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included. The study was carried out during 2015 and 2016.Frailty was defined using the 7-point Clinical Frailty Scale. The primary outcome was mortality at Day 90. Secondary outcomes included: mortality at Day 30, length of stay and readmission within a Day 30 period.Resultsthe cohort included 2,279 patients (median age 54 years [IQR 36–72]; 56% female). Frailty was documented in patients of all ages: 1% in the under 40’s to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90 (OR 1.80, 95% CI: 1.61–2.01) supporting a linear dose–response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.Conclusionsworsening frailty at any age is associated with significantly poorer patient outcomes, including mortality in unselected acute surgical admissions. Assessment of frailty should be integrated into emergency surgical practice to allow prognostication and implementation of strategies to improve outcomes.

KW - frailty

KW - mortality

KW - emergency surgical admissions

KW - all ages

KW - older people

UR - http://www.mendeley.com/research/frailty-predicts-mortality-emergency-surgical-admissions-regardless-age-observational-study

U2 - 10.1093/ageing/afy217

DO - 10.1093/ageing/afy217

M3 - Article

VL - 48

SP - 388

EP - 394

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 3

ER -