Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand.
Department of Surgery, Christchurch Hospital, Auckland, Aotearoa New Zealand.
World J Surg. 2024 May;48(5):1111-1122. doi: 10.1002/wjs.12141. Epub 2024 Mar 19.
An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long-term mortality and other important functional outcomes for older EL patients have not been fully explored.
A prospective multicenter study of older EL patients was conducted across four hospital sites in New Zealand from August 2017 to September 2022. The Clinical Frailty Scale (CFS) was used to measure frailty-defined as a CFS of ≥5. Primary outcomes were 30-day and one-year mortality. Secondary outcomes were postoperative morbidity, admission for rehabilitation, and increased care level on discharge. A multivariate logistic regression analysis was conducted, adjusting for age, sex, and ethnicity.
A total of 629 participants were included. Frailty prevalence was 14.6%. Frail participants demonstrated higher 30-day and 1-year mortality-20.7% and 39.1%. Following adjustment, frailty was directly associated with a significantly increased risk of short- and long-term mortality (30-day aRR 2.6, 95% CI 1.5, 4.3, p = <0.001, 1-year aRR 2.0, 95% CI 1.5, 2.8, p < 0.001). Frailty was correlated with a 2-fold increased risk of admission for rehabilitation and propensity of being discharged to an increased level of care, complications, and readmission within 30 days.
Frailty was associated with increased risk of postoperative mortality up to 1-year and other functional outcomes for older patients undergoing EL. Identification of frailty in older EL patients aids in patient-centered decision-making, which may lead to improvement in outcomes.
越来越多的老年患者接受急诊剖腹手术（EL）。虚弱被认为是导致该人群不良结局的原因之一。尚未充分探讨评估虚弱的最佳方法及其对老年 EL 患者的长期死亡率和其他重要功能结局的影响。
2017 年 8 月至 2022 年 9 月，在新西兰的四个医院进行了一项针对老年 EL 患者的前瞻性多中心研究。使用临床虚弱量表（CFS）来衡量虚弱程度，定义为 CFS≥5。主要结局是 30 天和 1 年死亡率。次要结局是术后发病率、康复入院和出院时增加护理级别。进行了多变量逻辑回归分析，调整了年龄、性别和种族。
共纳入 629 名参与者。虚弱的患病率为 14.6%。虚弱的参与者表现出更高的 30 天和 1 年死亡率，分别为 20.7%和 39.1%。调整后，虚弱与短期和长期死亡率的显著增加风险直接相关（30 天的校正相对风险 2.6，95%置信区间 1.5，4.3，p<0.001，1 年的校正相对风险 2.0，95%置信区间 1.5，2.8，p<0.001）。虚弱与康复入院和倾向于增加护理级别、30 天内并发症和再入院的风险增加呈两倍相关。
虚弱与老年接受 EL 患者的术后 1 年内死亡率增加和其他功能结局相关。在老年 EL 患者中识别虚弱有助于以患者为中心的决策，从而可能改善结局。
