General Surgery, Ministry of Health Holdings, Singapore.
Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Acad Med Singap. 2024 Jun 28;53(6):352-360. doi: 10.47102/annals-acadmedsg.2023155.
The global rise in ageing populations poses challenges for healthcare systems. By 2030, Singapore anticipates a quarter of its population to be aged 65 or older. This study addresses the dearth of research on frailty's impact on emergency laparotomy (EL) outcomes in this demographic, emphasising the growing significance of this surgical intervention.
Conducted at 2 tertiary centres in Singapore from January to December 2019, a retrospective cohort study examined EL outcomes in patients aged 65 or older. Frailty assessment, using the Clinical Frailty Scale (CFS), was integrated into demographic, diagnostic and procedural analyses. Patient data from Tan Tock Seng Hospital and Khoo Teck Puat Hospital provided a comprehensive view of frailty's role in EL.
Among 233 participants, 26% were frail, revealing a higher vulnerability in the geriatric population. Frail individuals exhibited elevated preoperative risk, prolonged ICU stays, and significantly higher 90-day mortality (21.3% versus 6.4%). The study illuminated a nuanced connection between frailty and adverse outcomes, underlining the critical need for robust predictive tools in this context.
Frailty emerged as a pivotal factor influencing the postoperative trajectory of older adults undergoing EL in Singapore. The integration of frailty assessment, particularly when combined with established metrics like P-POSSUM, showcased enhanced predictive accuracy. This finding offers valuable insights for shared decision-making and acute surgical unit practices, emphasising the imperative of considering frailty in the management of older patients undergoing emergency laparotomy.
全球人口老龄化的增长给医疗保健系统带来了挑战。到 2030 年，新加坡预计将有四分之一的人口年龄在 65 岁或以上。本研究针对这一年龄段人群中脆弱性对急诊剖腹手术（EL）结果的影响研究不足的问题，强调了这一手术干预的重要性日益增加。
本研究于 2019 年 1 月至 12 月在新加坡的 2 个三级中心进行，采用回顾性队列研究，对 65 岁或以上的 EL 患者的结局进行了研究。使用临床虚弱量表（CFS）对虚弱情况进行评估，并将其纳入人口统计学、诊断和程序分析。来自陈笃生医院和 Khoo Teck Puat 医院的数据提供了一个全面的视角，说明了虚弱在 EL 中的作用。
在 233 名参与者中，26%的人身体虚弱，这表明老年人群体的脆弱性更高。虚弱个体表现出更高的术前风险、更长的 ICU 停留时间和显著更高的 90 天死亡率（21.3%比 6.4%）。该研究阐明了虚弱与不良结局之间的细微联系，强调了在这种情况下需要强有力的预测工具。
虚弱是影响新加坡老年 EL 患者术后轨迹的关键因素。虚弱评估的纳入，特别是与 P-POSSUM 等既定指标结合使用，提高了预测的准确性。这一发现为共享决策和急性外科单位实践提供了有价值的见解，强调了在管理接受急诊剖腹手术的老年患者时考虑虚弱的重要性。
