Frailty Predicts Adverse Outcomes after Emergency General Surgery in Older Adults – A Multicentre Snapshot Audit on Frailty Prevalence in Irish Hospitals

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Introduction As the population ages, older patients with complex comorbidities are increasingly being admitted to hospitals with acute surgical pathology. Understanding the impact of frailty on unscheduled surgical care is needed to guide future service provision. This prospective collaborative study assessed the impact of frailty on outcomes after emergency general surgery. Methods Audit approval was granted for prospective snapshot study across eight hospitals. For fourteen consecutive days, all emergency general surgery admissions >60 years was screened for frailty using the Clinical Frailty Score. Electronic records were reviewed for demographics, comorbidities and inpatient course at 30 days, and the national death registry for twelve-month mortality. Outcomes between frail and non-frail patients were compared using SPSS. Results Across 112 call sessions, 277 patients >60 years were admitted. Mean age was 76.0 years (+/- 8.76) and 52% were frail (n=135/269). Across all admissions, 104 (41.6%) patients required a procedure and 46 (16.7%) required surgery. Similar numbers of frail and non-frail patients underwent surgery under general anaesthesia (14% vs 19.5%, p=0.264), though proportionally more frail patients required ICU care post-op (42% vs 22%). Out of 21 laparotomies, one patient was seen by a geriatrician. Frailty was associated with higher rates of any complication (p<0.001), nosocomial infection (p=0.013), cardiac morbidity (p=0.015) and delirium (p=0.023). Frail patients required significantly more medical consults (p=0.021) and MDT input (p<0.001), however only 16% were seen by a geriatrician (n=20/122). Frail patients had longer hospital stays (p=0.002), fewer discharges to home (p=0.004) and more 30-day readmissions (p=0.010). Significantly more frail patients were dead at one year (20% vs 8%, p=0.006). Conclusions High levels of frailty and frailty-associated morbidity were noted amongst emergency surgical admissions. Significant investment in collaborative pathways between surgeons and geriatricians is required to optimally manage this high-risk cohort.