Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2023
Even low-risk procedures pose hazards for frail patients.
Frailty, defined as accumulation of physiological deficits leading to overall deconditioning, has been linked to adverse outcomes in elective surgeries and high-risk procedures. However, the effects of frailty have not been studied in the emergency setting. In this retrospective study, researchers used a US surgical quality-improvement database to describe the role of frailty (using the Modified 5-Item Frailty Index) in 47,000 older patients (age, 65 years and older) who underwent emergency general surgery procedures within 48 hours of admission.
Among 17,000 patients who underwent low-risk emergency surgical procedures, 17% experienced postoperative complications by 30 days: failure to rescue (defined as mortality within 30 days of a complication) occurred in 1.0%, 1.2% died and 7.0% were readmitted. Among 30,000 patients who underwent high-risk emergency surgical procedures, 53% experienced postoperative complications by 30 days: failure to rescue occurred in 14%, 15% died and 10% were readmitted. In both groups, multivariable analysis revealed that increasing frailty was associated with higher levels of postoperative complications, failure to rescue and readmissions.
Comment: These associations between frailty and worse postoperative outcomes, even for low-risk procedures such as appendectomy or cholecystectomy, highlight the need for more attention to frailty prior to emergency surgery. Identifying these patients could inform preoperative discussions about expected outcomes and might influence choice of surgical procedure, type of anaesthesia and postoperative care. The retrospective design of this study is a limitation, but the results are plausible.
Andrew S. Parsons , MD, MPH
Assistant Professor of Medicine and Public Health, University of Virginia School of Medicine, Charlottesville, USA.
Collins CE, et al. Frailty in emergency general surgery: low-risk procedures pose similar risk as high-risk procedures for frail patients. Surgery 2023; 173: 485-491.
This summary is taken from the following Journal Watch titles: General Medicine, Emergency Medicine, Hospital Medicine