Quality-of-life following emergency laparotomy: is frailty a factor?

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Introduction More than half of patients undergoing emergency laparotomy (EL) are over 65 years of age, and frailty doubles the inpatient mortality for these patients. This study aims to measure quality-of-life (QoL) following EL, and determine whether outcomes are impacted by preoperative frailty. Methods We present four years of follow-up data (7 February 2020 to 5 February 2024) for patients who underwent EL at our single centre. Patients completed the 5-Level EQ-5D and 12-Item Short Form questionnaires at follow-up, the outcomes of which are presented. The responses of patients in low-risk (Clinical Frailty Score [CFS] 1–3, American Society of Anesthesiologists [ASA] grade 1–2) and high-risk (CFS 4–8, ASA 3–5) groups were compared. Results Some 988 patients were prospectively entered into the National Emergency Laparotomy Audit database during the study period. Of these, 590 patients (60%) were followed up, 40% were frail (CFS 4–8) and 57% had a high ASA grade (3–5). Overall, our cohort of patients had QoL outcomes that were between 4.6% (mental component) and 17.4% (physical component) lower than would be expected for the baseline population. Frail (CFS 4–8) and physiologically less fit (ASA 3–5) patients had significantly worse QoL outcomes (p < 0.001). Interestingly, stoma formation and presence of malignancy were not associated with significantly different QoL outcomes. Conclusion Our cohort of patients had a lower QoL following EL than the baseline population. High preoperative CFS or ASA grade was associated with lower QoL. Where appropriate during the consent process, surgeons should consider counselling frail and unfit patients regarding the potential for low QoL postoperatively.