Megan Power Foley1, Aimee Brennan2, Orla Conway3, Mohammed Al Azzawi4, Carolyn Cullinane5, Michael Devine3, Mohamed Ismail5, Czara Kennedy6, Aine O’Neill7, Nicola Raftery8, Eanna9, Conor Toale10
1Irish Surgical Research Collaborative, Dublin, Ireland;
2Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland;
3Department of Surgery, Mayo University Hospital, Castlebar, Ireland;
4Department of Surgery, Beaumont Hospital, Dublin, Ireland;
5Department of Surgery, University Hospital Limerick, Limerick, Ireland;
6Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland;
7Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland;
8Department of Surgery, St. James Hospital, Dublin, Ireland;
9Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland;
10Department of Surgery, Tallaght University Hospital, Dublin, Ireland
Background: As the population ages, older patients with complex comorbidities are increasingly being admitted to hospitals with surgical pathology. Understanding of the impact of frailty on unscheduled surgical care is needed to guide future service provision. This prospective collaborative study aimed to assess the impact of frailty on emergency general surgery admissions, followed up for mortality at 1 year.
Methods: A prospective snapshot audit was performed across eight hospitals. For 14 consecutive days, all emergency general surgery admissions >60 years were screened for frailty using the Clinical Frailty Score. Electronic records were reviewed for demographics, comorbidities, and inpatient course at 30 days. The national death registry was reviewed for 12-month mortality. Outcomes were compared between frail and non-frail patients using Statistical Package for the Social Sciences (SPSS).
Results: Across 112 call sessions, 277 patients >60 years were admitted. Mean age was 76.0±8.76 years, and 52% were frail (n=135/269). Across the spectrum of general surgery admissions, there was no difference in need for surgery (P=0.4) or intensive care unit (ICU) (P=0.975) between frail and non-frail cohorts. Frailty was associated with higher rates of any complication (P<0.001), nosocomial infection (P=0.01), cardiac morbidity (P=0.01), and delirium (P=0.02). Frail patients required significantly more medical consults (P=0.02) and MDT input (P<0.001). Frail patients had longer hospital stays (P=0.002), were less likely to be discharged home (P=0.004), and more likely to be readmitted within 30 days (P=0.010). Significantly more frail patients were dead at 1 year (20% vs. 8%, P=0.006). However, only 24 patients (9.2%) were seen by a geriatrician during index admission.
Conclusions: High levels of frailty and frailty-associated morbidity were noted amongst emergency surgical admissions. Significant investment in collaborative pathways between surgeons and geriatricians is required to optimally manage this high-risk cohort.
Keywords: Emergency general surgery; frailty; geriatrics; peri-operative complications; workforce planning
