Usefulness of the holistic context of frailty as a prognostic factor for the outcome of geriatric patients undergoing emergency abdominal surgery

  • Fernando Fuertes-GuiróEmail author
  • Eduardo Vitali-Erion
  • Amalia Rodriguez Fernandez
original article



This study aims to assess frailty in a holistic context as a prognostic factor for the outcomes of a group of geriatric patients undergoing emergency abdominal surgery, identifying the predictors that could be included in a global assessment score of preoperative frailty.


Four groups of predictors (physical, cognitive, functional, and social) were evaluated in a group of patients selected for abdominal surgery during the preoperative period. The outcomes for three groups of variables (mortality, morbidity, and use of health resources) were measured using multivariate logistic regression when the response variable is categorical, and the multiple linear regression model for continuous numeric response variables.


In the period studied, 286 patients aged 65 years or older required an emergency procedure. Physical/phenotypic predictors are consequently related to outcomes of morbidity and mortality and the use of resources, while predictors of mortality and socioeconomic factors predominate in functional and cognitive outcomes. Individually, Mini Nutritional Assessment (short form), sarcopenia, Pfeiffer, Barthel, and Duke tests best predict outcomes after emergency surgery.


Frailty is a predictive factor that should be routinely used in emergency geriatric surgery in a holistic context that includes physical, cognitive, functional, and social variables. Designing scores based on a broader concept of frailty will enable a more consistent predictive evaluation. Social frailty may have an important predictive value in the postoperative hospital outcome and in other medical fields, and should be studied in more depth in the future.


Frailty Geriatric surgery Prognostic factor Morbimortality Emergency surgery 


Conflict of interest

F. Fuertes-Guiró, E. Vitali-Erion, and A. Rodriguez Fernandez declare that they have no competing interests.


  1. 1.
    Fried LP, Hadley EC, Walston JD, Newman AB, Guralnik JM, Studenski S, Harris TB, Ershler WB, Ferrucci L. From bedside to bench: research agenda for frailty. Sci Aging Knowledge Environ. 2005;2005(31):e24.CrossRefGoogle Scholar
  2. 2.
    Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.CrossRefGoogle Scholar
  3. 3.
    Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.CrossRefGoogle Scholar
  5. 5.
    Walker JD. Aging and frailty in first nations communities. First nations information governance centre. Can J Aging. 2017;3:1–12.Google Scholar
  6. 6.
    Rockwood K, Hogan DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging. 2000;17(4):295–302.CrossRefGoogle Scholar
  7. 7.
    Shears M, McGolrick D, Waters B, Jakab M, Boyd JG, Muscedere J. Frailty measurement and outcomes in interventional studies: protocol for a systematic review of randomised control trials. BMJ Open. 2017;7(12):e18872.CrossRefGoogle Scholar
  8. 8.
    Torrance ADW, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med. 2015;7:55–68.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Søreide K, Desserud KF. Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scand J Trauma Resusc Emerg Med. 2015;23:10.CrossRefGoogle Scholar
  10. 10.
    Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short form mini nutritional assessment (MNA-SF). J Gerontol. 2001;56A:M366–M77.CrossRefGoogle Scholar
  11. 11.
    Rubbieri G, Mossello E, Di Bari M. Techniques for the diagnosis of sarcopenia. Clin Cases Miner Bone Metab. 2014;11(3):181–4.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Med Care. 1988;26(7):709–23.CrossRefGoogle Scholar
  13. 13.
    Agostini JV, Inouye SK. Delirium. In: Hazzard WR, Blass JP, Halter JB, Ouslander JG, Tinetti ME, editors. Principles of geriatric medicine and gerontology. 5th ed. New York: McGraw-Hill; 2003. pp. 1503–15.Google Scholar
  14. 14.
  15. 15.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRefGoogle Scholar
  16. 16.
    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.CrossRefGoogle Scholar
  17. 17.
    Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206(4):544–50.CrossRefGoogle Scholar
  18. 18.
    Mosquera C, Spaniolas K, Fitzgerald TL. Impact of frailty on surgical outcomes: the right patient for the right procedure. Surgery. 2016;160(2):272–80.CrossRefGoogle Scholar
  19. 19.
    Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7.CrossRefGoogle Scholar
  20. 20.
    Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16:157.CrossRefGoogle Scholar
  21. 21.
    Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. Emergency general surgery specific frailty index: a validation study. J Trauma Acute Care Surg. 2016;81(2):254–60.CrossRefGoogle Scholar
  22. 22.
    Robinson TN, Walston JD, Brummel NE, Deiner S, Brown CH, Kennedy M, Hurria A. Frailty for surgeons: review of a national institute on aging conference on frailty for specialists. J Am Coll Surg. 2015;221(6):1083–92.CrossRefGoogle Scholar
  23. 23.
    Judith SL, Danielle P, Jugdeep H, Dhesi K. Frailty in the older surgical patient: a review. Age Ageing. 2012;41(2):142–7.CrossRefGoogle Scholar
  24. 24.
    Cooper C, Fielding R, Visser M, van Loon LJ, Rolland Y, Orwoll E, Reid K, Boonen S, Dere W, Epstein S, Mitlak B, Tsouderos Y, Sayer AA, Rizzoli R, Reginster JY, Kanis JA. Tools in the assessment of sarcopenia. Calcif Tissue Int. 2013;93(3):201–10.CrossRefGoogle Scholar
  25. 25.
    Quinn TJ, McArthur K, Ellis G, Stott DJ. Functional assessment in older people. BMJ. 2011;343:d4681.CrossRefGoogle Scholar
  26. 26.
    Villarejo A, Puertas-Martín V. Usefulness of short tests in dementia screening. Neurologia. 2011;26(7):425–33.CrossRefGoogle Scholar
  27. 27.
    Mc Dowell I. Measuring health: a guide to rating scales and questionnaires. 3rd ed. Oxford: Oxford University Press; 2006. pp. 150–203.CrossRefGoogle Scholar
  28. 28.
    Marufu TC, ManningsIain A, Moppett K. Risk scoring models for predicting peri-operative morbidity and mortality in people with fragility hip fractures: Qualitative systematic review. Injury. 2015;46(12):2325–34.CrossRefGoogle Scholar
  29. 29.
    Schmidta M, Eckardtb R, Altmeppena S, Werneckec KD, Spiesa C. Functional impairment prior to major non-cardiac surgery is associated with mortality within one year in elderly patients with gastrointestinal, gynaecological and urogenital cancer: A prospective observational cohort study. J Geriatr Oncol. 2018;9(1):53–9.CrossRefGoogle Scholar
  30. 30.
    Calvo E, Teruel L, Rosenfeld L, Guerrero C, Romero M, Romaguera R, Izquierdo S, Asensio S, Andreu-Periz L, Gómez-Hospital JA, Ariza-Solé A. Frailty in elderly patients undergoing primary percutaneous coronary intervention. Eur J Cardiovasc Nurs. 2018; Scholar
  31. 31.
    Vetrano DL, Landi F, De Buyser SL, Carfì A, Zuccalà G, Petrovic M, Volpato S, Cherubini A, Corsonello A, Bernabei R, Onder G. Predictors of length of hospital stay among older adults admitted to acute care wards: a multicentre observational study. Eur J Intern Med. 2014;25(1):56–62.CrossRefGoogle Scholar
  32. 32.
    Agboado G, Peters J, Donkin L. Factors influencing the length of hospital stay among patients resident in blackpool admitted with COPD: a cross-sectional study. BMJ Open. 2012;2(5):e869.CrossRefGoogle Scholar
  33. 33.
    Bo M, Fonte G, Pivaro F, Bonetto M, Comi C, Giorgis V, Marchese L, Isaia G, Maggiani G, Furno E, Falcone Y, Isaia GC. Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatr Gerontol Int. 2016;16(3):314–21.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryFaculty of Medicine and Health Sciences. Universitat Internacional de Catalunya and QSalud University HospitalsSant Cugat del Vallés, BarcelonaSpain
  2. 2.Department of SurgeryQSalud University HospitalsBarcelonaSpain

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