Abstract

GARZON, Horacio et al. Surgical frailty: a postoperative morbidity and mortality predictive factor in the elderly undergoing emergency surgery. rev. colomb. cir. [online]. 2014, vol.29, n.4, pp.278-292. ISSN 2011-7582.

Introduction/aim: The association between frailty and worse outcomes in emergency abdominal surgery has not been totally evaluated. There is no available information in Colombia. The objective of this study was to establish the relationship between frailty with mortality, morbidity and readmission rates within the first 30 postoperative days, in a prospective cohort of elderly patients undergoing emergency abdominal surgery. Methods: The Canadian Study of Health and Aging Clinical Frailty Scale (CSHA) was applied to elderly patients (>65 years) on admission to the emergency room to, in order to determine the association between CHSA clinical frailty scale, demographic, clinical and surgical factors with the probability of complications, death and readmission, applying the Chi-square and Fisher's exact tests. Multivariate analyses were conducted to identify the independent association of previous significant factors with major outcomes. Survival analysis was performed by Kaplan-Meier analysis with a log-rank test. Results: A total of 300 consecutive patients fulfilled the inclusion criteria and were included. The global mortality rate was 14% (42 patients), the morbidity rate was 27.6% (83 patients) and the readmission rate was 15.67% (47 patients). Fifteen percent presented frailty degree (CSHA Clinical Frailty Scale>5). The main independent factor associated with mortality was a CSHA Frailty Scale >5 (OR:4,49 p<0,001). The main independent factors associated with morbidity were the CSHA Frailty Scale >5 (OR:2,78 p<0,014) and LoS >12 days (OR:6,83 p<0,001). The independent factors associated with readmission were malnutrition (OR:1.97 p<0,04) and previous major surgery (OR:2.27 p<0,04). Conclusion: In the elderly population undergoing emergency abdominal surgery surgical frailty is associated with postoperative morbidity and mortality rates. Frailty did not appear associated with the factors that determined readmission within the first 30 days. Additional interventions are needed to control the frailty factor in the perioperative period, which must be evaluated in new studies.

Keywords : aged; fragility; risk factors; malnutrition; morbidity; mortality.

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