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.
Comments
That's such an important finding about the CFS4 group. The link to shared decision-making and its impact on longer-term care planning is key. Thank you for sharing your research.
binary classification
Great poster - really interested to hear about the inadequacy of binary classification as I am looking at how we can improve accuracy of frailty scoring on our emergency surgery wards. This cements in my mind that we need to ensure this is not 'dumbed down' for the sake of convenience (hope that makes sense!)
It does make sense. I think what the results made me consider is that across the spectrum of frailty, there are different priorities and different approaches may be beneficial. So accuracy of scoring is really important in triggering the right kind of input… but takes time to get there. Would love to chat sometime about your role
getting in touch
Would also like hear more about your research - please do get in touch - ruth.bryant@nhs.net. Thank you