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Frailty Assessment Can Enhance Current Risk Prediction Tools in Emergency Laparotomy: A Retrospective Cohort Study

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Abstract

Objective

We set out to assess the performance of the P-POSSUM and NELA risk prediction tool (NELA RPT), and hypothesized that combining them with the Clinical Frailty Scale (CFS) would significantly improve their performance.

Summary background data

Emergency laparotomy (EL) is a high-risk surgical intervention, particularly for elderly patients with marked comorbidities and frailty. Accurate risk prediction is crucial for appropriate resource allocation, clinical decision making, and informed consent. Although patient frailty is a significant risk factor, the current risk prediction tools fail to take frailty into account.

Methods

In this retrospective single-center cohort study, we analyzed all cases entered into the NELA database from the Oxford University Hospitals between 01.01.2018 and 15.06.2021. We analyzed the performance of the P-POSSUM and NELA RPT. Both tools were modified by adding the CFS to the model.

Results

The discrimination of both the P-POSSUM and NELA RPT was good, with a slightly worse performance in the elderly. Adding CFS into the P-POSSUM and NELA RPT models improved both tools in the elderly [AUC from 0.775 to 0.846 (p < 0.05) from 0.814 to 0.864 (p < 0.05), respectively]. The improvement of the NELA RPT across all age groups did not reach statistical significance. The CFS grade was associated with 30-day mortality in patients aged > 65 years. However, in younger patients, this effect was less marked than in the elderly.

Conclusion

Our analysis demonstrated a significant improvement in the P-POSSUM and NELA risk models when combined with the CFS. Frailty also increases the 30-day mortality after EL in younger individuals.

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Acknowledgements

We acknowledge the NELA team for sharing part of their database with us for this research project.

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Authors and Affiliations

  1. Oxford University Hospitals NHS Trust Surgical Emergency Unit, Oxford, UK

    Shoaib Hussain, Maseh Sadiqi & Giles Bond-Smith

  2. Faculty of Medicine, Tartu University, Sütiste Tee 19, 13419, Tallinn, Tartu, Estonia

    Karl G. Isand, Ülle Kirsimägi, Helgi Kolk, Sten Saar, Urmas Lepner & Peep Talving

Authors
  1. Karl G. Isand
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  2. Shoaib Hussain
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  3. Maseh Sadiqi
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  4. Ülle Kirsimägi
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Corresponding author

Correspondence to Karl G. Isand.

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Conflict of interest

Each author confirms that they have no conflicts of interest.

Ethical approval

This study was approved by the Oxford University NHS Trust (Approved Local Audit no. 7023) and was conducted in accordance with the ethical standards of the Helsinki Declaration of 1975.

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Appendices

Appendix 1

See Table

Table 7 Parameters used to calculate P-POSSUM* and NELA-RPT** predicted mortality
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7

Appendix 2

The Clinical Frailty Scale

figure a

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Isand, K.G., Hussain, S., Sadiqi, M. et al. Frailty Assessment Can Enhance Current Risk Prediction Tools in Emergency Laparotomy: A Retrospective Cohort Study. World J Surg 47, 2688–2697 (2023). https://doi.org/10.1007/s00268-023-07140-z

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