TY - JOUR
T1 - Frailty Assessment in the Emergency Department for Patients ≥80 Years Undergoing Urgent Major Surgical Procedures
AU - Covino, Marcello
AU - Salini, Sara
AU - Russo, Andrea
AU - De Matteis, Giuseppe
AU - Simeoni, Benedetta
AU - Maccauro, Giulio
AU - Sganga, Gabriele
AU - Landi, Francesco
AU - Gasbarrini, Antonio
AU - Franceschi, Francesco
PY - 2022
Y1 - 2022
N2 - Objectives: To evaluate, in a cohort of adults ≥80 years old, the frailty status at the emergency department (ED) admission, for the in-hospital death risk stratification of patients needing major surgical procedures. Design: Single-center prospective observational cohort study. Setting and Participants: The study was conducted in the ED of a teaching hospital. We enrolled all patients ≥80 years old consecutively admitted to the ED for conditions requiring urgent surgical procedures, between 2018 and 2021. Methods: Clinical variables and frailty status assessed in the ED were evaluated for the association with all-cause in-hospital death. The parameters evaluated were frailty [assessed by the Clinical Frailty Scale (CFS)], comorbidities, physiological parameters, type of surgery needed, laboratory values at admission. Cox regression analysis was used to identify independent risk factors for poor outcomes. Results: The study enrolled 1039 patients aged ≥80 years [median age 85 years (interquartile range 82-89); 445 males (42.8%)]. Overall, 127 patients (12.2%) were classified as nonfrail (CFS score 1-3), 722 (69.5%) as mild frail (CFS score 4-6), and 190 (18.3%) as frail (CFS score 7-9). The covariate-adjusted analysis revealed that severe frailty [hazard ratio (HR) 12.55, 95% CI 2.96-53.21, P = .016], ≥3 comorbidities (HR 2.08, 95% CI 1.31-3.31, P = .002), shock at ED presentation (HR 3.58, 95% CI 2.16-5.92, P < .001), anemia (HR 1.88, 95% CI 1.17-3.04, P = .009), and neurosurgery procedures (HR 3.97, 95% CI 1.98-7.96, P < .001) were independent risk factors for in-hospital death. Conclusions and Implications: In patients aged ≥80 years undergoing urgent surgical procedures, the evaluation of functional status in the ED could predict the risk of in-hospital death. Frail patients have an increased risk of death and major complications, whereas those with mild frailty have a similar prognosis compared with the more fit ones. Nonsurgical management should be considered in the case of severely frail and comorbid patients aged ≥80 years needing neurosurgery or abdominal surgery.
AB - Objectives: To evaluate, in a cohort of adults ≥80 years old, the frailty status at the emergency department (ED) admission, for the in-hospital death risk stratification of patients needing major surgical procedures. Design: Single-center prospective observational cohort study. Setting and Participants: The study was conducted in the ED of a teaching hospital. We enrolled all patients ≥80 years old consecutively admitted to the ED for conditions requiring urgent surgical procedures, between 2018 and 2021. Methods: Clinical variables and frailty status assessed in the ED were evaluated for the association with all-cause in-hospital death. The parameters evaluated were frailty [assessed by the Clinical Frailty Scale (CFS)], comorbidities, physiological parameters, type of surgery needed, laboratory values at admission. Cox regression analysis was used to identify independent risk factors for poor outcomes. Results: The study enrolled 1039 patients aged ≥80 years [median age 85 years (interquartile range 82-89); 445 males (42.8%)]. Overall, 127 patients (12.2%) were classified as nonfrail (CFS score 1-3), 722 (69.5%) as mild frail (CFS score 4-6), and 190 (18.3%) as frail (CFS score 7-9). The covariate-adjusted analysis revealed that severe frailty [hazard ratio (HR) 12.55, 95% CI 2.96-53.21, P = .016], ≥3 comorbidities (HR 2.08, 95% CI 1.31-3.31, P = .002), shock at ED presentation (HR 3.58, 95% CI 2.16-5.92, P < .001), anemia (HR 1.88, 95% CI 1.17-3.04, P = .009), and neurosurgery procedures (HR 3.97, 95% CI 1.98-7.96, P < .001) were independent risk factors for in-hospital death. Conclusions and Implications: In patients aged ≥80 years undergoing urgent surgical procedures, the evaluation of functional status in the ED could predict the risk of in-hospital death. Frail patients have an increased risk of death and major complications, whereas those with mild frailty have a similar prognosis compared with the more fit ones. Nonsurgical management should be considered in the case of severely frail and comorbid patients aged ≥80 years needing neurosurgery or abdominal surgery.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Clinical Frailty Scale
KW - Emergency Service, Hospital
KW - Frail Elderly
KW - Frailty
KW - Geriatric Assessment
KW - Hospital Mortality
KW - Humans
KW - Male
KW - Prospective Studies
KW - Urgent surgical procedures
KW - multimorbidity
KW - older adults
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Clinical Frailty Scale
KW - Emergency Service, Hospital
KW - Frail Elderly
KW - Frailty
KW - Geriatric Assessment
KW - Hospital Mortality
KW - Humans
KW - Male
KW - Prospective Studies
KW - Urgent surgical procedures
KW - multimorbidity
KW - older adults
UR - http://hdl.handle.net/10807/200103
U2 - 10.1016/j.jamda.2021.12.039
DO - 10.1016/j.jamda.2021.12.039
M3 - Article
SN - 1525-8610
VL - 23
SP - 581
EP - 588
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
ER -