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February 27, 2016Journal of the American College of Surgeons

Emergency General Surgery in the Elderly: Too Old or Too Frail?

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Why the study?

Does the Rockwood frailty index predict outcomes in elderly patients undergoing emergency general surgery?

Population

220 geriatric patients undergoing emergency general surgery at a single institution during a 2-year period.

Design

Cohort

Follow-up

In-hospital

Authors

BJBellal JosephBZBardiya ZangbarVPViraj Pandit

Discussion

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Overview

May support frailty screening for risk stratification in elderly emergency general surgery; leaves open whether mitigation strategies reduce complications.

Key Points

  • To evaluate the utility of an established 50-variable Rockwood Frailty Index in predicting postoperative outcomes among elderly patients undergoing emergency general surgery.
  • Conducted a prospective cohort study over a 2-year period at a single institution enrolling patients aged 65 years and older undergoing emergency general surgery (N = 220).
  • Assessed preadmission frailty using the modified 50-variable Rockwood Preadmission Frailty Index (defining frailty as a score ≥ 0.25) and analyzed outcomes via multivariate regression.
  • Frailty was identified in 37% (n = 82) of patients and independently predicted in-hospital complications (OR = 2.13; 95% CI, 1.09–4.16; p = 0.02) and major complications (OR = 3.87; 95% CI, 1.69–8.84; p = 0.001).
  • Postoperative complications occurred in 35% (n = 77) of patients and major complications in 19% (n = 42); chronological age and American Society of Anesthesiologists score did not predict complications.
  • The frailty index model demonstrated 80% sensitivity, 72% specificity, and an area under the curve of 0.75, while all patients who died (overall mortality 3.2%, n = 7) were frail.

Structured PICO

Does the Rockwood frailty index predict outcomes in elderly patients undergoing emergency general surgery?

P
Population
220 geriatric patients (aged 65 years and older) undergoing emergency general surgery (EGS) at a single institution during a 2-year period.
I
Intervention
Frailty assessment using the modified 50-variable Rockwood Preadmission Frailty Index (FI)
O
Outcome
In-hospital complications, development of major complications, and mortalityhard clinical

The Rockwood frailty index independently predicts postoperative complications and mortality in elderly patients undergoing emergency general surgery, outperforming chronological age.

Cite This Study

Joseph et al. (2016) studied this question.

synapsesocial.com/papers/6a90e8ea9eff36e44092cd95https://doi.org/10.1016/j.jamcollsurg.2016.01.063
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Emergency general surgery specific frailty index2016 · 132 citations
  2. 2Impact of Procedure Risk vs Frailty on Outcomes of Elderly Patients Undergoing Emergency General Surgery: Results of a National Analysis2024 · 17 citations
  3. 3Measuring the Predictive Accuracy of Preoperative Clinical Frailty Instruments Applied to Electronic Health Data in Older Patients Having Emergency General Surgery2022 · 17 citations
  4. 4Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis2021 · 40 citations
  5. 5MTP8.12 Frailty Assessment in Emergency Surgical Patients2025