Abstract
Objective:
Frailty patients undergoing emergency laparotomy (EmLap) experienced increased perioperative morbidity and mortality. We aim to explore the association between frailty scoring in EmLap older adults (>65 years) and 1-year post-operative morbidity and social care changes.
Methods:
Retrospective analysis was performed on the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database (2018-2019). Older adults with completed preoperative scoring markers (National Emergency Laparotomy Audit (NELA) and Rockwood Frailty Score (RFS)) were included. ‘Frail’ was defined as RFS>3 and ‘morbidity’ as presentation to Emergency Department (ED)/hospital readmission within 12 months post-EmLap. Social care changes include change in package of care (POC).
Results:
The 46 patients included had a median age of 74.5 years: 72% female and 33% frail. Of frail patients, 40% were readmitted to hospital while 53% presented to ED: 25% from surgical complications. 20% of frail patients had increased POC. Univariate analysis found association between frailty and presentation to hospital with OR of 1.59 (95%CI of 0.88-3.04, P=0.13). The preoperative NELA scoring had OR of 1.08 (P=0.077) for predicting presentation to ED.
Conclusion:
Almost a third of older adults admitted for EmLap are frail. This study demonstrated an association between frailty and long-term morbidity which also affects the post-operative social care.