Frailty as a predictor of postoperative morbidity and mortality in older patients undergoing emergency laparotomy: a prospective cohort study in Yemen.

BACKGROUND

Emergency laparotomy (EL) in older patients is associated with high postoperative risk. Frailty, a state of increased vulnerability, is a recognized risk factor; however, its specific impact on EL, especially in resource-constrained settings such as Yemen, requires further elucidation. This study aimed to evaluate the predictive value of frailty, assessed using the Clinical Frailty Scale (CFS), for postoperative morbidity and 30-day mortality in patients aged ≥ 60 years who underwent EL in Sana'a, Yemen.

METHODS

This prospective cohort study enrolled 89 patients who underwent EL et al.-Gomhori Teaching Hospital (January 2023-December 2024). Frailty (CFS ≥ 5) was assessed preoperatively. The outcomes included complications, length of stay (LOS), and 30-day mortality. Data were analyzed using descriptive statistics, chi-square/Fisher's exact tests, t-test/Mann-Whitney U tests, Kaplan-Meier survival analysis, and logistic regression.

RESULTS

The prevalence of frailty was 19.1% (N = 17). Patients with frailty had significantly higher rates of sepsis (41.2% vs. 15.3%, p = 0.017), cardiac complications (76.5% vs. 31.9%, p = 0.001), renal impairment (64.7% vs. 36.1%, p = 0.031), cerebrovascular accidents (CVA) (41.2% vs. 18.1%, p = 0.040), and deep venous thrombosis (DVT) (23.5% vs. 4.2%, p = 0.008). The unadjusted 30-day mortality rate was significantly higher in frail patients (58.8% vs. 23.6%; odds ratio (OR) 4.62, 95% Confidence Interval (CI) 1.53-14.00, p = 0.005). Kaplan-Meier analysis confirmed poorer survival in the frail group (p = 0.005). After adjusting for age and American Society of Anesthesiologists (ASA) status, frailty was associated with increased odds of mortality (AOR 2.725, 95% CI, 0.785-9.461; p = 0.114). LOS did not differ significantly (p = 0.729), likely due to the higher mortality rate in the frail group.

CONCLUSION

Frailty was a common and significant predictor of postoperative morbidity and unadjusted 30-day mortality in the Yemeni cohort of older patients who underwent EL. Routine CFS assessment can aid in risk stratification and inform perioperative strategies to improve outcomes in this vulnerable population; however, further investigation with larger cohorts is required to confirm its independent effect in multivariate models.