Key result
Frailty is linked to ~130% higher risk of severe complications after emergency laparotomy.
Why the study?
Emergency laparotomy is a morbid and mortal operation, and factors associated with perioperative outcomes require better understanding.
Are frailty and female sex associated with significant complications in patients undergoing emergency laparotomy?
Observational (n=371)
No
Are frailty and female sex associated with significant complications in patients undergoing emergency laparotomy?
Odds Ratio: 2.3 (95% CI 1.03–5.13)
p-value: p=0.03
Frailty and female sex are significant independent predictors of major postoperative complications following emergency laparotomy.
May inform risk stratification before emergency laparotomy; hypothesis-generating and requires prospective validation before practice change.
Background: Emergency laparotomy is a morbid and mortal operation that is often performed as a lifesaving treatment in the acutely unwell surgical patient. This study assessed morbidity and mortality in patients undergoing emergency abdominal surgery in an Australian metropolitan hospital to improve our understanding of factors that are associated with perioperative outcome. Methods: Patients were identified from a high-volume institution between 01 March 2018 and 01 February 2022. Baseline, operative and postoperative parameters were collected and analysed for associations with significant complications, defined as Clavien-Dindo (CD) scores of 3 or greater, using a binary logistic regression. Results: Independent predictors of ≥CD 3 complications were female sex (p=0.02, OR: 2.36 (95% CI 1.10, 5.05)) and frailty (p=0.03, OR: 2.30 (95% CI 1.03, 5.13)). Mortality rate in our cohort was 3.5%. Twelve of 13 deceased patients were female, all were frail and were of advanced age (mean 83.1 years). Conclusions: An improved recognition of frailty and the assessment of frailty in the acutely unwell surgical patient requiring an emergency laparotomy is required to aid perioperative assessment and decision making.
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Matthew J. McMahon (2024) conducted an observational in Emergency laparotomy (n=371). Frailty (Clinical Frailty Score ≥ 4) vs. Non-frail (Clinical Frailty Score < 4) was evaluated on Severe complications (Clavien-Dindo score ≥ 3) (OR 2.30, 95% CI 1.03, 5.13, p=0.03). Frailty was independently associated with a significantly increased risk of severe postoperative complications (OR 2.30) in patients undergoing emergency laparotomy.
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