Impact of preoperative frailty on outcomes in patients subjected to emergency laparotomy: a prospective study.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.