Ng Hwei Jene, Rattray Nicholas J W, Quasim Tara, Moug Susan J
Department of General Surgery, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Corsebar Road, Paisley, PA2 9PN, UK.
College of Medical, Veterinary and Life Sciences, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
World J Emerg Surg. 2025 Apr 25;20(1):37. doi: 10.1186/s13017-025-00612-8.
Pre-operative frailty adversely affects morbidity and mortality after emergency laparotomy (EmLap), especially in older adults (65 years and above). Little is known about frailty after EmLap. We explored the change in frailty status from pre- to post-EmLap and any influence on discharge destination.
EmLap patients aged ≥ 65years from an acute surgical site were recruited from May 2022 to April 2023. Prospective data collection included demographics, frailty, mortality and discharge destination. Frailty was assessed using the Rockwood Clinical Frailty Scale at pre-EmLap and day-90 post-EmLap (< 4 as non-frail, 4 as pre-frail and > 4 as frail). EmLap patients with no 90-day follow-up were excluded. A p-value of < 0.05 was considered significant.
63 EmLap patients were included in the study. The median age was 75 years (range 65-91 years) with 36 (57.1%) females. Eleven (17.5%) were living with frailty pre-EmLap, and 10 (15.9%) developed new frailty by day-90 post-EmLap. Pre-EmLap, all patients came from home with 20.6% of the frail and pre-frail group having a package of care service (POC) in place. On 90-day post-EmLap, 1 was still an inpatient but 25.8% had a change in discharge destination: care home (n = 1), home with new POC (n = 2) and home with increased POC (n = 13). Of the 16 patients with change of discharge destination, 9 (56.3%) were frail pre-EmLap. There was a significant association between pre-EmLap frailty and change in home circumstances on discharge (p < 0.00001).
Emergency surgery can increase a patient's frailty status and significantly increases care requirements and social support after hospital discharge. Frailty assessment needs to be performed before and after admission in all EmLap patients to improve post-EmLap care planning and patient expectations.
术前虚弱对急诊剖腹手术后的发病率和死亡率有不利影响，尤其是在老年人（65岁及以上）中。关于急诊剖腹手术后的虚弱情况知之甚少。我们探讨了急诊剖腹手术前后虚弱状态的变化以及对出院目的地的任何影响。
2022年5月至2023年4月招募了来自急性外科手术部位的年龄≥65岁的急诊剖腹手术患者。前瞻性数据收集包括人口统计学、虚弱情况、死亡率和出院目的地。在急诊剖腹手术前和术后90天使用Rockwood临床虚弱量表评估虚弱情况（<4为非虚弱，4为虚弱前期，>4为虚弱）。排除没有90天随访的急诊剖腹手术患者。p值<0.05被认为具有统计学意义。
63例急诊剖腹手术患者纳入研究。中位年龄为75岁（范围65 - 91岁），女性36例（57.1%）。11例（17.5%）在急诊剖腹手术前存在虚弱，10例（15.9%）在术后90天出现新的虚弱。急诊剖腹手术前，所有患者均来自家庭，虚弱和虚弱前期组中有20.6%有一整套护理服务（POC）。术后90天，1例仍为住院患者，但25.8%的患者出院目的地发生了变化：养老院（n = 1）、有新POC的家庭（n = 2）和POC增加的家庭（n = 13）。在16例出院目的地发生变化的患者中，9例（56.3%）在急诊剖腹手术前虚弱。急诊剖腹手术前的虚弱与出院时家庭情况的变化之间存在显著关联（p < 0.00001）。
急诊手术会增加患者的虚弱状态，并显著增加出院后的护理需求和社会支持。所有急诊剖腹手术患者在入院前后都需要进行虚弱评估，以改善急诊剖腹手术后的护理计划和患者预期。
