98frailty in Older Patients Undergoing Emergency Laparotomy: Further Results From the Elf Study (Emergency Laparotomy and Frailty)

Introduction: Frailty has been shown to predict older adult (≥65 years) outcomes in medical and elective surgical settings. Frailty scoring has not yet been assessed in emergency laparotomy, despite older adults now comprising the majority of patients undergoing emergency laparotomy and carrying the highest risk of both post-operative complications and post-operative mortality. Methods: This is a multi-centre (n = 49) UK-based observational study of 937 older adults (≥65 years) undergoing emergency laparotomy. The Clinical Frailty Score (CFS) ranging from 1 to 7 (CFS 1–4 non-frail; CFS 5–7 frail) was used for pre-operative frailty scoring. Inclusion criteria were in line with the National Emergency Laparotomy Audit (NELA). The primary outcome measure was 90 day post-operative mortality. Secondary outcomes measures included 30-day mortality, length of ICU stay, length of overall hospital stay, change in level of care and discharge destination. Results: Frailty was present in 20% of participants with an overall 90-day mortality of 19.5%. The risk of 90-day mortality was directly associated with frailty: CFS 5 had aOR of 3.18 and CFS 6/7 aOR 6.10 compared to CFS 1. Frailty was also associated with a significantly increased risk of complications, length of ICU stay and overall length of stay. A change in care level required was observed between admission and discharge in 37.5% of patients. After adjusting for age, sex, and care-level on admission, the risk of requiring an increased level of care at discharge following emergency laparotomy was directly associated with frailty. Conclusions: Frailty is associated with a significantly increased risk of post-operative mortality and morbidity, irrespective of age. Additionally, increasing frailty score is more independently associated with increased level of care on discharge, and more predictive than admission care level. Frailty scoring should therefore be integrated into routine practice to aid decision-making with older surgical patients.