B. Park1, E. Sulistio1, A. Barazanchi1, A. Vandal1, J. Koea1, A. Hill1, A. MacCormick1 1University Of Auckland, Auckland, -, New Zealand
Introduction: Emergency laparotomy (EL) has high rates of morbidity and mortality. Frailty assessment remains underutilised in this setting, in part due to time constraints and feasibility. The Clinical Frailty Scale (CFS) has been identified as the most appropriate tool for frailty assessment in EL patients and is recommended for all older patients undergoing EL. The prognostic impact of measured frailty using the CFS on short- and long-term mortality and morbidity outcomes remains to be determined.
Methods: Observational cohort studies were identified by systematically searching Medline, EMBASE, Scopus and CENTRAL databases, comparing outcomes following EL for frail and non-frail participants defined according to the CFS. The primary outcomes were short- and long-term mortality. A random effects model was created with pooling of effect estimates and a separate narrative synthesis was created. Risk of bias was assessed.
Results: Twelve articles comprising 5,704 patients were included. Frailty prevalence was 25 percent in all patients and 32 percent in older adults (age ≥55). Older patients with frailty had a significantly greater risk of postoperative mortality (30-day mortality OR 3.84, 95% CI 2.90, 5.09, one-year mortality OR 3.03, 95% CI 2.17, 4.23). Meta-regression revealed that variations in cut-off values to define frailty did not significantly affect the association with frailty and 30-day mortality. Frailty was associated with higher rates of major complications (OR 1.93, 95% CI 1.27, 2.93) and discharge to an increased level of care.
Conclusion: Frailty is significantly correlated with short- and long-term mortality following EL, as well as adverse morbidity and functional outcomes. Identifying frailty using the CFS may aid in patient-centred decision-making and implementation of tailored care strategies for these ‘high-risk’ patients, with the aim to reduce adverse outcomes following EL.