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Open Access 01-12-2019 | Abdominal Surgery | Research article

Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study

Authors: Hwee Leong Tan, Shermain Theng Xin Chia, Nivedita Vikas Nadkarni, Shin Yuh Ang, Dennis Chuen Chai Seow, Ting Hway Wong

Published in: World Journal of Emergency Surgery | Issue 1/2019

Abstract

Background

Frailty has been associated with an increased risk of adverse postoperative outcomes in elderly patients. We examined the impact of preoperative frailty on loss of functional independence following emergency abdominal surgery in the elderly.

Methods

This prospective cohort study was performed at a tertiary hospital, enrolling patients 65 years of age and above who underwent emergency abdominal surgery from June 2016 to February 2018. Premorbid variables, perioperative characteristics and outcomes were collected. Two frailty measures were compared in this study—the Modified Fried’s Frailty Criteria (mFFC) and Modified Frailty Index-11 (mFI-11). Patients were followed-up for 1 year.

Results

A total of 109 patients were prospectively recruited. At baseline, 101 (92.7%) were functionally independent, of whom seven (6.9%) had loss of independence at 1 year; 28 (25.7%) and 81 (74.3%) patients were frail and non-frail (by mFFC) respectively. On univariate analysis, age, Charlson Comorbidity Index and frailty (mFFC) (univariate OR 13.00, 95% CI 2.21–76.63, p < 0.01) were significantly associated with loss of functional independence at 1 year. However, frailty, as assessed by mFI-11, showed a weaker correlation than mFFC (univariate OR 4.42, 95% CI 0.84–23.12, p = 0.06). On multivariable analysis, only premorbid frailty (by mFFC) remained statistically significant (OR 15.63, 95% CI 2.12–111.11, p < 0.01).

Conclusions

The mFFC is useful for frailty screening amongst elderly patients undergoing emergency abdominal surgery and is a predictor for loss of functional independence at 1 year. Including the risk of loss of functional independence in perioperative discussions with patients and caregivers is important for patient-centric emergency surgical care. Early recognition of this at-risk group could help with discharge planning and priority for post-discharge support should be considered.

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Title: Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study
Authors: Hwee Leong Tan
Shermain Theng Xin Chia
Nivedita Vikas Nadkarni
Shin Yuh Ang
Dennis Chuen Chai Seow
Ting Hway Wong
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Abdominal Surgery
Published in: World Journal of Emergency Surgery / Issue 1/2019
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-019-0280-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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