Key result
In 59,633 elderly patients undergoing emergency general surgery, procedure risk had a stronger association with mortality, complications, failure to rescue, and readmissions compared with frailty.
Why the study?
The direct association between procedure risk and outcomes in elderly emergency general surgery patients had not been analyzed, with existing studies focusing primarily on frailty.
Does procedure risk have a stronger association with adverse outcomes than frailty in elderly patients undergoing emergency general surgery?
Cohort (n=59,633)
Yes
Does procedure risk have a stronger association with adverse outcomes than frailty in elderly patients undergoing emergency general surgery?
In elderly patients undergoing emergency general surgery, procedure risk is a stronger predictor of adverse outcomes than frailty alone.
Answers are grounded in this paper and cite their sources.
Prioritizing procedure risk over frailty may refine risk stratification in elderly emergency surgery; leaves open prospective validation of targeted interventions.
BACKGROUND: The direct association between procedure risk and outcomes in elderly patients who undergo emergency general surgery (EGS) has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly patients who undergo EGS is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly patients who undergo EGS compared with frailty. STUDY DESIGN: Elderly patients (age >65 years) undergoing EGS operative procedures were identified in the NSQIP database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5-Item Frailty Index (mFI-5; mFI 0 nonfrail, mFI 1 to 2 frail, and mFI ≥3 severely frail) and based on procedure risk. Multivariable regression models and receiving operative curve analysis were used to determine risk factors associated with outcomes. RESULTS: A total of 59,633 elderly patients who underwent EGS were classified into nonfrail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group. Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared with frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly patients who underwent EGS compared with frailty. CONCLUSIONS: Assessing frailty in the population of elderly patients who undergo EGS without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.
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Zakhary et al. (2024) conducted a cohort in Emergency general surgery (n=59,633). High procedure risk vs. Low procedure risk was evaluated on Mortality, complications, failure to rescue, and readmissions. In 59,633 elderly patients undergoing emergency general surgery, procedure risk had a stronger association with mortality, complications, failure to rescue, and readmissions compared with frailty.
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