Isand Karl G, Aim Allan, Bahhir Artjom, Uuetoa Marit, Kolk Helgi, Saar Sten, Lepner Urmas, Talving Peep
North Estonia Medical Centre, Sütiste tee 19, Tallinn, 13419, Estonia.
East Tallinn Central Hospital, Tallinn, Estonia.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):34. doi: 10.1007/s00068-024-02752-z.
Emergency laparotomy (EL) is a high-risk procedure, especially in frail patients. This study investigates the prevalence of frailty in referral facilities, evaluates the impact of frailty on postoperative morbidity and mortality, and assesses the long-term effect of EL on patients' functional status.
This prospective multicentre cohort study included patients aged 50 years and older who underwent EL. Frailty was assessed using the Clinical Frailty Scale (CFS). The primary outcome measure was the prevalence of frailty and its impact on the 180-day mortality rate after EL. Secondary outcomes were 30- and 90-day mortality, complications requiring invasive procedures, length of hospital stay (LOS), and changes in CFS and in living arrangement at six months post-operation.
The study enrolled 251 patients with a median age of 73 years. Frailty was prevalent, with 57.8% of patients classified as frail (CFS 5-9). In Cox regression analysis, the hazard ratios of 180-day mortality with 95% confidence intervals were 2.4 (0.8-7.1) for CFS 4, 7.5 (2.8-20.0) for CFS 5, 14.4 (5.5-37.8) for CFS 6-8, and 28.7 (9.7-84.6) for CFS 9, compared to non-frail patients. Increasing frailty was also associated with higher 30 and 90- day mortality, increased risk of complications, and prolonged LOS. Additionally, at six months post-EL, patients experienced a further decline in functional status compared to their preoperative state.
The 180-day mortality after EL is significantly higher for patients on higher levels of frailty. Likewise, the preoperative frailty has a significant negative impact on postoperative outcomes both short- and long-term.
急诊剖腹手术（EL）是一项高风险手术，尤其是对身体虚弱的患者。本研究调查了转诊机构中虚弱的患病率，评估了虚弱对术后发病率和死亡率的影响，并评估了急诊剖腹手术对患者功能状态的长期影响。
这项前瞻性多中心队列研究纳入了年龄在50岁及以上接受急诊剖腹手术的患者。使用临床虚弱量表（CFS）评估虚弱程度。主要结局指标是虚弱的患病率及其对急诊剖腹手术后180天死亡率的影响。次要结局指标包括30天和90天死亡率、需要侵入性操作的并发症、住院时间（LOS）以及术后六个月时临床虚弱量表和生活安排的变化。
该研究招募了251名患者，中位年龄为73岁。虚弱情况普遍存在，57.8%的患者被归类为虚弱（临床虚弱量表评分为5 - 9分）。在Cox回归分析中，与非虚弱患者相比，临床虚弱量表评分为4分时180天死亡率的风险比及95%置信区间为2.4（0.8 - 7.1），评分为5分时为7.5（2.8 - 20.0），评分为6 - 8分时为14.4（5.5 - 37.8），评分为9分时为28.7（9.7 - 84.6）。虚弱程度增加还与30天和90天死亡率升高、并发症风险增加以及住院时间延长相关。此外，在急诊剖腹手术后六个月，患者的功能状态与术前相比进一步下降。
急诊剖腹手术后，虚弱程度较高的患者180天死亡率显著更高。同样，术前虚弱对术后短期和长期结局均有显著负面影响。
