2663 Estimating the effect of frailty on long term survival following emergency laparotomy

Abstract

Introduction Around 30,000 emergency laparotomies are performed each year across the United Kingdom. Over half are in people aged 65 years or above, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but longer-term mortality risk has been less extensively studied, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on longer-term mortality (> 90 days) following emergency laparotomy. Methods A retrospective analysis of National Emergency Laparotomy Audit (NELA) data was undertaken, including records entered between 01/12/18 and 30/11/20. Baseline patient characteristics including Clinical Frailty Scale (CFS) are routinely collected within NELA. Data are linked via NHS Digital with Office for National Statistics mortality data. A multivariate analysis was undertaken using a Cox proportional hazards model with hospital-level random effects. Potential confounders were identified via a directed acyclic graph and included in the model as covariates. Results 23,290 patients remained alive at 90 days post-surgery and were therefore included in the analysis. After adjusting for other covariates, increasing frailty was associated with an increased risk of longer-term mortality. Compared with CFS 1–3, adjusted HR were 1.86 (95% CI 1.68–2.05) for CFS 4, 2.23 (95% CI 2.03–2.45) for CFS 5, 3.26 (95% CI 2.99–3.57) for CFS 6, 4.53 (95% CI 3.97 (95% CI 5.17) for CFS 7, 5.80 (95% CI 4.44–7.57) for CFS 8 and 5.36 (95% CI 4.06–7.08) for CFS 9. Conclusion Older people living with frailty remain at increased risk of death beyond 90 days following emergency laparotomy. This information should be incorporated into shared decision-making, enabling patients to make informed choices about their care. Future work must explore how outcomes for this group might be improved through targeted post-operative support.