Gilan Waleed Mohammed, Obadiel Yasser Abdurabo, Hashem Ameen Fuad, Aiash Shehab Abdulhameed, Jowah Haitham Mohammed
Department of Surgery, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
Department of Surgery, Al-Gomhori Teaching Hospital Authority, Sana'a, Yemen.
BMC Geriatr. 2025 Jul 31;25(1):567. doi: 10.1186/s12877-025-06222-y.
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.
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.
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.
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.
老年患者进行急诊剖腹手术（EL）术后风险较高。虚弱是一种易损性增加的状态，是公认的风险因素；然而，其对急诊剖腹手术的具体影响，尤其是在也门等资源有限的地区，仍需进一步阐明。本研究旨在评估使用临床虚弱量表（CFS）评估的虚弱对也门萨那年龄≥60岁接受急诊剖腹手术患者术后发病率和30天死亡率的预测价值。
这项前瞻性队列研究纳入了89例在戈莫里教学医院接受急诊剖腹手术的患者（2023年1月至2024年12月）。术前评估虚弱情况（CFS≥5）。结局指标包括并发症、住院时间（LOS）和30天死亡率。使用描述性统计、卡方检验/费舍尔精确检验、t检验/曼-惠特尼U检验、卡普兰-迈耶生存分析和逻辑回归分析数据。
虚弱的患病率为19.1%（N = 17）。虚弱患者的败血症发生率（41.2%对15.3%，p = 0.017）、心脏并发症发生率（76.5%对31.9%，p = 0.001）、肾功能损害发生率（64.7%对36.1%，p = 0.031）、脑血管意外（CVA）发生率（41.2%对18.1%，p = 0.040）和深静脉血栓形成（DVT）发生率（23.5%对4.2%，p = 0.008）显著更高。未调整的30天死亡率在虚弱患者中显著更高（58.8%对23.6%；比值比（OR）4.62，95%置信区间（CI）1.53 - 14.00，p = 0.005）。卡普兰-迈耶分析证实虚弱组的生存率较差（p = 0.005）。在调整年龄和美国麻醉医师协会（ASA）状态后，虚弱与死亡几率增加相关（调整后比值比2.725，95% CI，0.785 - 9.461；p = 0.114）。住院时间无显著差异（p = 0.729），可能是由于虚弱组死亡率较高。
在也门接受急诊剖腹手术的老年患者队列中，虚弱是术后发病率和未调整的30天死亡率的常见且重要预测因素。常规CFS评估有助于进行风险分层，并为围手术期策略提供信息以改善这一脆弱人群的结局；然而，需要更大队列的进一步研究来证实其在多变量模型中的独立作用。
