Frailty predicts mortality in all emergency surgical admissions regardless of age: An observational study

J. Hewitt; 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

doi:10.1093/ageing/afy217

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

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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 language	English
Pages (from-to)	388-394
Number of pages	7
Journal	Age and Ageing
Volume	48
Issue number	3
Early online date	19 Feb 2019
DOIs	https://doi.org/10.1093/ageing/afy217
Publication status	Published - May 2019

Bibliographical 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.).

Keywords

frailty
mortality
emergency surgical admissions
all ages
older people

Access to Document

10.1093/ageing/afy217Licence: Unspecified

Accepted Manuscript
This is a pre-copyedited, author-produced version of an article accepted for publication in Age And Ageing following peer review. The version of record J Hewitt, 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, Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study, Age and Ageing, Volume 48, Issue 3, May 2019, Pages 388–394, is available online at: https://doi.org/10.1093/ageing/afy217
Accepted author manuscript, 248 KBLicence: Unspecified
Supplement InformationAccepted author manuscript, 131 KBLicence: Unspecified

Cite this

@article{f6ca04bc7fee4ec68fea1e457586e305,

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{\textquoteright}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{\textquoteright}s College London (B.C.).",

year = "2019",

month = may,

doi = "10.1093/ageing/afy217",

language = "English",

volume = "48",

pages = "388--394",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "OXFORD UNIV PRESS INC",

number = "3",

}

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

C2 - 30778528

SN - 0002-0729

VL - 48

SP - 388

EP - 394

JO - Age and Ageing

JF - Age and Ageing

IS - 3

ER -

Frailty predicts mortality in all emergency surgical admissions regardless of age: An observational study

Abstract

Bibliographical note

Keywords

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Phyo Myint, Clinical Chair in Medicine of Old Age

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Frailty predicts mortality in all emergency surgical admissions regardless of age: An observational study

Abstract

Bibliographical note

Keywords

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Other files and links

Fingerprint

Profiles

Phyo Myint, Clinical Chair in Medicine of Old Age

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