IMPACT OF FRAILTY ON OUTCOMES AFTER EMERGENCY GENERAL SURGERY: A COMPARATIVE ANALYSIS OF PREDICTIVE MEASURES
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Abstract
Introduction: Frailty significantly impacts outcomes in emergency general surgery (EGS), but comparative data on frailty instrument performance in this population are limited. This study compared the discriminatory power of four frailty measures for predicting adverse outcomes in a national EGS cohort.
Methods: Adults undergoing common EGS procedures (large/small bowel resection, perforated ulcer repair, cholecystectomy, appendectomy, lysis of adhesions, laparotomy) were identified in the 2006-2007 Nationwide Readmissions Database. Patients were categorized as frail or non-frail using the Hospital Frailty Risk Score (HFRS), modified 5-factor Frailty Index (mFI-5), modified 11-factor Frailty Index (mFI-11). Multivariable logistic regression was used to assess the independent association between each frailty measure and in-hospital mortality and a composite of perioperative complications.
Results: Among 1,385,505 EGS hospitalizations, frailty prevalence varied: 57.0% (mFI-11), 29.9% (HFRS), 26.6% (mFI-5), and 10.5% (ACG). After adjustment, HFRS demonstrated the highest discriminatory power for predicting both mortality and complications. Frail patients identified by HFRS had the greatest adjusted odds ratios for mortality (7.8, 95% CI 7.4-8.3) and composite complications (8.4, 95% CI 9.3-8.5) across all frailty levels.
Conclusion: In EGS patients, HFRS exhibited superior discriminatory power for predicting mortality and perioperative complications compared to mFI-5, mFI-11, and ACG. Risk stratification efforts in older EGS patients should prioritize HFRS to optimize clinical outcomes and resource allocation.
References
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Dr. Satish Baburao Rajurkar
Assistant Professor, General Surgery, Mamata Medical College, Khammam.