The impact of frailty on 30-day outcomes for older emergency general surgery admissions in Irish hospitals - A multicentre snapshot prospective audit.

INTRODUCTION

As the population ages, more older patients with complex comorbidities are presenting with acute surgical pathology. Frailty is strongly associated with higher complication rates, functional decline and healthcare costs. This prospective collaborative study assessed the impact of frailty on outcomes after emergency general surgery in patients aged ≥65 years to guide future service provision.

METHODS

Through the Irish Surgical Research Collaborative, approval was granted for prospective snapshot audit in eight Irish hospitals. For fourteen consecutive days, all emergency general surgery admissions ≥65 years were screened for frailty using the Clinical Frailty Score. Demographics, comorbidities and inpatient course at 30 days were compared between frail and non-frail patients using SPSS.

RESULTS

In 112 cal l sessions, 244 patients ≥65 years were admitted and 55.5% were frail (n = 134/241). Frail patients were significantly older (p < 0.001), with higher rates of multimorbidity (p < 0.001), polypharmacy (p < 0.001), and both physical (p < 0.001) and cognitive impairment (p < 0.001). Similar numbers of frail and non-frail patients underwent surgery under general anaesthesia, though proportionally more frail patients required ICU care post-op. Frailty was associated with significantly higher rates of all inpatient complications (p < 0.001), including nosocomial infection (p = 0.034), cardiac events (p = 0.026), delirium (p = 0.025) and death (p = 0.016). Frail patients required significantly more medical consults (p = 0.034), MDT input (p < 0.001) and increased home-care packages (p = 0.024). Frail patients had longer hospital stays (p = 0.033) and fewer discharges to home (p < 0.001).

CONCLUSIONS

High levels of frailty and frailty-associated morbidity were noted amongst emergency surgical admissions. Collaborative pathways between surgeons and geriatricians may optimise outcomes in this high-risk cohort.