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Frailty as a predictor of mortality in the elderly emergency general surgery patient

(2017) ACTA CHIRURGICA BELGICA. 117(6). p.370-375
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Abstract
Background: The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. Methods: We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk. Results: Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p = .025) (hazard ratio (HR) 10.83 (95% CI 1.34-87.4)). Operation (p = .084) (HR 0.16 (95% CI 0.16-1.29)) and the presence of chronic cardiac failure (p = .049) (HR 0.38 (95% CI 0.14-0.99)) were protective for mortality at 90 days. Conclusion: Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery.
Keywords
Elderly patient, frailty, mortality, readmission, acute abdominal surgery, POOR SURGICAL OUTCOMES, COGNITIVE IMPAIRMENT, OLDER-ADULTS, PREVALENCE, ASSOCIATION, MULTICENTER, DISABILITY

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Citation

Please use this url to cite or link to this publication:

MLA
Goeteyn, Jens et al. “Frailty as a Predictor of Mortality in the Elderly Emergency General Surgery Patient.” ACTA CHIRURGICA BELGICA 117.6 (2017): 370–375. Print.
APA
Goeteyn, J., Evans, L. A., De Cleyn, S., fauconnier, S., Damen, C., Hewitt, J., & Ceelen, W. (2017). Frailty as a predictor of mortality in the elderly emergency general surgery patient. ACTA CHIRURGICA BELGICA, 117(6), 370–375.
Chicago author-date
Goeteyn, Jens, Louis A Evans, Siem De Cleyn, Sigrid fauconnier, Caroline Damen, Jonathan Hewitt, and Wim Ceelen. 2017. “Frailty as a Predictor of Mortality in the Elderly Emergency General Surgery Patient.” Acta Chirurgica Belgica 117 (6): 370–375.
Chicago author-date (all authors)
Goeteyn, Jens, Louis A Evans, Siem De Cleyn, Sigrid fauconnier, Caroline Damen, Jonathan Hewitt, and Wim Ceelen. 2017. “Frailty as a Predictor of Mortality in the Elderly Emergency General Surgery Patient.” Acta Chirurgica Belgica 117 (6): 370–375.
Vancouver
1.
Goeteyn J, Evans LA, De Cleyn S, fauconnier S, Damen C, Hewitt J, et al. Frailty as a predictor of mortality in the elderly emergency general surgery patient. ACTA CHIRURGICA BELGICA. 2017;117(6):370–5.
IEEE
[1]
J. Goeteyn et al., “Frailty as a predictor of mortality in the elderly emergency general surgery patient,” ACTA CHIRURGICA BELGICA, vol. 117, no. 6, pp. 370–375, 2017.
@article{8535602,
  abstract     = {Background: The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days. 
Methods: We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann-Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk. 
Results: Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p = .053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p = .025) (hazard ratio (HR) 10.83 (95% CI 1.34-87.4)). Operation (p = .084) (HR 0.16 (95% CI 0.16-1.29)) and the presence of chronic cardiac failure (p = .049) (HR 0.38 (95% CI 0.14-0.99)) were protective for mortality at 90 days. 
Conclusion: Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery.},
  author       = {Goeteyn, Jens and Evans, Louis A and De Cleyn, Siem and Fauconnier, Sigrid and Damen, Caroline and Hewitt, Jonathan and Ceelen, Wim},
  issn         = {0001-5458},
  journal      = {ACTA CHIRURGICA BELGICA},
  keywords     = {Elderly patient,frailty,mortality,readmission,acute abdominal surgery,POOR SURGICAL OUTCOMES,COGNITIVE IMPAIRMENT,OLDER-ADULTS,PREVALENCE,ASSOCIATION,MULTICENTER,DISABILITY},
  language     = {eng},
  number       = {6},
  pages        = {370--375},
  title        = {Frailty as a predictor of mortality in the elderly emergency general surgery patient},
  url          = {http://dx.doi.org/10.1080/00015458.2017.1337339},
  volume       = {117},
  year         = {2017},
}

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