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Impact of frailty in surgical emergencies. A comparison of four frailty scales

Abstract

Introduction

Frailty is a geriatric syndrome, leading to declines in homeostatic reserve and physical resistance. It has been considered as a risk factor for falls, fractures, need of institutionalization, length of stay and mortality. Our aim was to evaluate the relationship between frailty, 30-day postoperative mortality and morbidity, for elderly patients undergoing surgical emergencies.

Material and methods

Prospective, observational cohort Study (September 2017–April 2019), using four different frailty scales (Clinical Frailty Scale, FRAIL scale, TRST and Share-FI) as a risk factor of 30-day postoperative outcomes, for patients older than 70 years undergoing emergency surgery. We analyzed diagnoses, clinical examination at admission, surgical procedures, and postoperative outcomes during the first 30 days or until discharge.

Results

92 patients were included, with a mean age was 78.7 years (SD 6.3). Frailty prevalence varied since 14.1% obtained using FRAIL scale, to 25%, 29.2% and 30.4%, from Clinical Frailty Scale, TRST and Share-FI, respectively. All four frailty scales show statistical differences to predict major complication and mortality in our sample. FRAIL scale showed the highest sensitivity–specificity pair to predict mortality in our sample (AUC = 0.870). TRST and FRAIL scales showed the strongest measure of association (OR 7.69 and 5.92, respectively) for major complications. Regarding need for admission to the ICU, hospital stay or reoperation rate, only FRAIL scale showed a statistically significant association.

Conclusion

Frailty represents a predictive marker of mortality and major complications, in surgical emergencies. FRAIL score, shows the strongest relationship with mortality and complications, compared to other frailty scales.

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Fig. 1

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Funding

The authors declare that no funding was received in relation to this article.

Author information

Correspondence to Alejandro Sánchez Arteaga.

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Conflict of interest

The authors declare that they have no conflicts of interest in relation to this article.

Ethical responsibilities

The study was approved by the Ethics Committee of Hospital Universitario Virgen del Rocío. All participants granted their consent to participate in the study. All of the authors have confirmed the preservation of confidentiality and respect of patients’ rights in the document of author responsibilities, publication agreement and transfer of rights to the European Journal of Trauma and Emergency Surgery.

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Arteaga, A.S., Aguilar, L.T., González, J.T. et al. Impact of frailty in surgical emergencies. A comparison of four frailty scales. Eur J Trauma Emerg Surg (2020). https://doi.org/10.1007/s00068-020-01314-3

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Keywords

  • Elderly patient
  • Frailty
  • Surgical emergencies
  • Frailty scales