Emergency General Surgery in the Elderly: Too Old or Too Frail? Presented orally at the Surgical Forum of the American College of Surgeons 100th Annual Clinical Congress, San Francisco, CA, October 2014.

Bellal A Joseph, Bardiya Zangbar, Viraj Pandit, Mindy J Fain, Martha J Mohler, Narong Kulvatunyou, Tahereh Orouji Jokar, Terence S Okeeffe, Randall S Friese, Peter M Rhee

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Abstract

Background Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index. Study Design We prospectively measured preadmission frailty in all geriatric (aged 65 years and older) patients undergoing EGS at our institution during a 2-year period. Frailty index (FI) was calculated using the modified 50-variable Rockwood Preadmission FI. Frail patients were defined by FI ≥ 0.25. Outcomes measures were in-hospital complications, development of major complications, and mortality. Multivariate regression analysis was performed. Results A total of 220 patients were enrolled, of which 82 (37%) were frail. Frailty index score did not correlate with age (R = 0.64; R2 = 0.53; p = 0.1) and poorly correlated with American Society of Anesthesiologists score (R = 0.51; R2 = 0.44; p = 0.045). Thirty-five percent (n = 77) of patients had postoperative complications and 19% (n = 42) had major complications. Frailty index was an independent predictor for development of in-hospital complications (odds ratio = 2.13; 95% CI, 1.09-4.16; p = 0.02) and major complications (odds ratio = 3.87; 95% CI, 1.69-8.84; p = 0.001). Age and American Society of Anesthesiologists score were not predictive of postoperative and major complications. Our FI model had 80% sensitivity, 72% specificity, and area under the curve of 0.75 in predicting complications in geriatric patients undergoing EGS. The overall mortality rate was 3.2% (n = 7) and all patients who died were frail. Conclusions Frailty index independently predicts postoperative complications, major complications, and hospital length of stay in elderly patients undergoing emergency general surgery. Use of FI will provide insight into the hospital course of elderly patients, allowing for identification of patients in need and more efficient allocation of hospital resources.

Original languageEnglish (US)
Pages (from-to)805-813
Number of pages9
JournalJournal of the American College of Surgeons
Volume222
Issue number5
DOIs
StatePublished - May 1 2016

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San Francisco
Emergencies
Geriatrics
Length of Stay
Odds Ratio
Resource Allocation
Mortality
Area Under Curve
Multivariate Analysis
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

@article{7d663db6e8574134b37d6065bdb0b522,
title = "Emergency General Surgery in the Elderly: Too Old or Too Frail? Presented orally at the Surgical Forum of the American College of Surgeons 100th Annual Clinical Congress, San Francisco, CA, October 2014.",
abstract = "Background Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index. Study Design We prospectively measured preadmission frailty in all geriatric (aged 65 years and older) patients undergoing EGS at our institution during a 2-year period. Frailty index (FI) was calculated using the modified 50-variable Rockwood Preadmission FI. Frail patients were defined by FI ≥ 0.25. Outcomes measures were in-hospital complications, development of major complications, and mortality. Multivariate regression analysis was performed. Results A total of 220 patients were enrolled, of which 82 (37{\%}) were frail. Frailty index score did not correlate with age (R = 0.64; R2 = 0.53; p = 0.1) and poorly correlated with American Society of Anesthesiologists score (R = 0.51; R2 = 0.44; p = 0.045). Thirty-five percent (n = 77) of patients had postoperative complications and 19{\%} (n = 42) had major complications. Frailty index was an independent predictor for development of in-hospital complications (odds ratio = 2.13; 95{\%} CI, 1.09-4.16; p = 0.02) and major complications (odds ratio = 3.87; 95{\%} CI, 1.69-8.84; p = 0.001). Age and American Society of Anesthesiologists score were not predictive of postoperative and major complications. Our FI model had 80{\%} sensitivity, 72{\%} specificity, and area under the curve of 0.75 in predicting complications in geriatric patients undergoing EGS. The overall mortality rate was 3.2{\%} (n = 7) and all patients who died were frail. Conclusions Frailty index independently predicts postoperative complications, major complications, and hospital length of stay in elderly patients undergoing emergency general surgery. Use of FI will provide insight into the hospital course of elderly patients, allowing for identification of patients in need and more efficient allocation of hospital resources.",
author = "Joseph, {Bellal A} and Bardiya Zangbar and Viraj Pandit and Fain, {Mindy J} and Mohler, {Martha J} and Narong Kulvatunyou and Jokar, {Tahereh Orouji} and Okeeffe, {Terence S} and Friese, {Randall S} and Rhee, {Peter M}",
year = "2016",
month = "5",
day = "1",
doi = "10.1016/j.jamcollsurg.2016.01.063",
language = "English (US)",
volume = "222",
pages = "805--813",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Emergency General Surgery in the Elderly

T2 - Too Old or Too Frail? Presented orally at the Surgical Forum of the American College of Surgeons 100th Annual Clinical Congress, San Francisco, CA, October 2014.

AU - Joseph, Bellal A

AU - Zangbar, Bardiya

AU - Pandit, Viraj

AU - Fain, Mindy J

AU - Mohler, Martha J

AU - Kulvatunyou, Narong

AU - Jokar, Tahereh Orouji

AU - Okeeffe, Terence S

AU - Friese, Randall S

AU - Rhee, Peter M

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index. Study Design We prospectively measured preadmission frailty in all geriatric (aged 65 years and older) patients undergoing EGS at our institution during a 2-year period. Frailty index (FI) was calculated using the modified 50-variable Rockwood Preadmission FI. Frail patients were defined by FI ≥ 0.25. Outcomes measures were in-hospital complications, development of major complications, and mortality. Multivariate regression analysis was performed. Results A total of 220 patients were enrolled, of which 82 (37%) were frail. Frailty index score did not correlate with age (R = 0.64; R2 = 0.53; p = 0.1) and poorly correlated with American Society of Anesthesiologists score (R = 0.51; R2 = 0.44; p = 0.045). Thirty-five percent (n = 77) of patients had postoperative complications and 19% (n = 42) had major complications. Frailty index was an independent predictor for development of in-hospital complications (odds ratio = 2.13; 95% CI, 1.09-4.16; p = 0.02) and major complications (odds ratio = 3.87; 95% CI, 1.69-8.84; p = 0.001). Age and American Society of Anesthesiologists score were not predictive of postoperative and major complications. Our FI model had 80% sensitivity, 72% specificity, and area under the curve of 0.75 in predicting complications in geriatric patients undergoing EGS. The overall mortality rate was 3.2% (n = 7) and all patients who died were frail. Conclusions Frailty index independently predicts postoperative complications, major complications, and hospital length of stay in elderly patients undergoing emergency general surgery. Use of FI will provide insight into the hospital course of elderly patients, allowing for identification of patients in need and more efficient allocation of hospital resources.

AB - Background Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index. Study Design We prospectively measured preadmission frailty in all geriatric (aged 65 years and older) patients undergoing EGS at our institution during a 2-year period. Frailty index (FI) was calculated using the modified 50-variable Rockwood Preadmission FI. Frail patients were defined by FI ≥ 0.25. Outcomes measures were in-hospital complications, development of major complications, and mortality. Multivariate regression analysis was performed. Results A total of 220 patients were enrolled, of which 82 (37%) were frail. Frailty index score did not correlate with age (R = 0.64; R2 = 0.53; p = 0.1) and poorly correlated with American Society of Anesthesiologists score (R = 0.51; R2 = 0.44; p = 0.045). Thirty-five percent (n = 77) of patients had postoperative complications and 19% (n = 42) had major complications. Frailty index was an independent predictor for development of in-hospital complications (odds ratio = 2.13; 95% CI, 1.09-4.16; p = 0.02) and major complications (odds ratio = 3.87; 95% CI, 1.69-8.84; p = 0.001). Age and American Society of Anesthesiologists score were not predictive of postoperative and major complications. Our FI model had 80% sensitivity, 72% specificity, and area under the curve of 0.75 in predicting complications in geriatric patients undergoing EGS. The overall mortality rate was 3.2% (n = 7) and all patients who died were frail. Conclusions Frailty index independently predicts postoperative complications, major complications, and hospital length of stay in elderly patients undergoing emergency general surgery. Use of FI will provide insight into the hospital course of elderly patients, allowing for identification of patients in need and more efficient allocation of hospital resources.

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