Key result
Frailty assessed by the Clinical Frailty Scale was associated with a significantly greater risk of 30-day mortality (OR 3.84; 95% CI 2.90-5.09) following emergency laparotomy in older patients.
Why the study?
The prognostic impact of measured frailty using the Clinical Frailty Scale on short- and long-term mortality and morbidity rates after emergency laparotomy remains to be determined.
Does frailty assessed by the Clinical Frailty Scale predict short- and long-term mortality and morbidity in patients undergoing emergency laparotomy?
Meta-Analysis (n=5,704)
Does frailty assessed by the Clinical Frailty Scale predict short- and long-term mortality and morbidity in patients undergoing emergency laparotomy?
Odds Ratio: 3.84 (95% CI 2.9–5.09)
Frailty assessed by the Clinical Frailty Scale is strongly associated with increased short- and long-term mortality and major complications following emergency laparotomy.
May inform preoperative risk assessment in older adults undergoing emergency laparotomy; leaves open whether frailty interventions improve outcomes.
BACKGROUND: Emergency laparotomy has high morbidity and mortality rates. Frailty assessment remains underutilized in this setting, in part due to time constraints and feasibility. The Clinical Frailty Scale has been identified as the most appropriate tool for frailty assessment in emergency laparotomy patients and is recommended for all older patients undergoing emergency laparotomy. The prognostic impact of measured frailty using the Clinical Frailty Scale on short- and long-term mortality and morbidity rates remains to be determined. METHODS: Observational cohort studies were identified by systematically searching Medline, Embase, Scopus and CENTRAL databases up to February 2024, comparing outcomes following emergency laparotomy for frail and non-frail participants defined according to the Clinical Frailty Scale. The primary outcomes were short- and long-term mortality rates. A random-effects model was created with pooling of effect estimates and a separate narrative synthesis was created. Risk of bias was assessed. RESULTS: Twelve articles comprising 5704 patients were included. Frailty prevalence was 25% in all patients and 32% in older adults (age ≥55 years). Older patients with frailty had a significantly greater risk of postoperative death (30-day mortality rate OR 3.84, 95% c.i. 2.90 to 5.09, 1-year mortality rate OR 3.03, 95% c.i. 2.17 to 4.23). Meta-regression revealed that variations in cut-off values to define frailty did not significantly affect the association with frailty and 30-day mortality rate. Frailty was associated with higher rates of major complications (OR 1.93, 95% c.i. 1.27 to 2.93) and discharge to an increased level of care. CONCLUSION: Frailty is significantly correlated with short- and long-term mortality rates following emergency laparotomy, as well as an adverse morbidity rate and functional outcomes. Identifying frailty using the Clinical Frailty Scale may aid in patient-centred decision-making and implementation of tailored care strategies for these 'high-risk' patients, with the aim of reducing adverse outcomes following emergency laparotomy.
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Park et al. (2024) conducted a meta-analysis in Emergency laparotomy (n=5,704). Frailty (assessed by the Clinical Frailty Scale) vs. Non-frail participants was evaluated on 30-day mortality rate (OR 3.84, 95% CI 2.90 to 5.09). Frailty assessed by the Clinical Frailty Scale was associated with a significantly greater risk of 30-day mortality (OR 3.84; 95% CI 2.90-5.09) following emergency laparotomy in older patients.
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