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

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Summary

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya and QSalud University Hospitals, C/Josep Trueta, s/n, 08195, Sant Cugat del Vallés, Barcelona, Spain

    Fernando Fuertes-Guiró MD, PhD

  2. Department of Surgery, QSalud University Hospitals, Barcelona, Spain

    Eduardo Vitali-Erion MD & Amalia Rodriguez Fernandez MD

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  1. Fernando Fuertes-Guiró MD, PhD
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  3. Amalia Rodriguez Fernandez MD
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Correspondence to Fernando Fuertes-Guiró MD, PhD.

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

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Fuertes-Guiró, F., Vitali-Erion, E. & Rodriguez Fernandez, A. Usefulness of the holistic context of frailty as a prognostic factor for the outcome of geriatric patients undergoing emergency abdominal surgery. Eur Surg 51, 261–270 (2019). https://doi.org/10.1007/s10353-019-0580-2

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