Impact of frailty on outcomes following emergency laparotomy: a retrospective analysis across diverse clinical conditions

被引:0
|
作者
Isand, Karl G. [1 ]
Hussain, Shoaib Fahad [2 ]
Sadiqi, Maseh [2 ]
Kirsimagi, Ulle [3 ]
Bond-Smith, Giles [2 ]
Kolk, Helgi [3 ]
Saar, Sten [1 ]
Lepner, Urmas [3 ]
Talving, Peep [1 ]
机构
[1] North Estonia Med Ctr, Sutiste Tee 19, EE-13419 Tallinn, Estonia
[2] Oxford Univ Hosp NHS Fdn Trust, Surg Emergency Unit, Oxford, England
[3] Tartu Univ, Fac Med, Tartu, Estonia
关键词
Frailty; Emergency laparotomy; Survival; Delay to surgery; GENERAL-SURGERY; SURGICAL DELAY; RELIABILITY; TIME; RISK;
D O I
10.1007/s00068-024-02632-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose Emergency laparotomy (EL) encompasses procedures of varying complexity and urgency, undertaken in different clinical scenarios, leading to different risks of morbidity and mortality. We hypothesized that the increased mortality and longer postoperative length of stay (LoS) observed in frail patients are related to differences in indication for operation, a higher rate of sepsis, worse intraperitoneal soiling, and more advanced malignancy in this group. Methods This retrospective cohort study analysed patients entered into the National Emergency Laparotomy Audit database between January 1, 2018, and June 15, 2021, in Oxford. The primary outcome was 180-day survival analysed using multivariable Cox regression. The secondary outcomes, delay to surgery (DtS) and postoperative LoS, were analysed using logarithmically transformed multivariable linear regression. Results Of the 803 patients analysed, 396 (49.3%) were male. The median age was 66, and 337 (42%) were living with at least very mild frailty. Mortality hazard ratios for Clinical Frailty Scale grades 4 (3.93, 95% CI 1.89-8.20), 5 (5.86, 95% CI 2.87-11.97), and 6-7 (14.17, 95% CI 7.33-27.40) were not confounded by indication, sepsis, intraperitoneal soiling, or malignancy status. Frail patients experienced a 1.38-fold longer DtS and a 1.24-fold longer postoperative LoS, even after adjusting for indication, sepsis, intraperitoneal soiling, malignancy status, and DtS. Conclusion Our results indicate that frail patients have a poorer prognosis and longer postoperative LoS, independent of DtS, indication, sepsis, intraperitoneal soiling, and malignancy status. Patient frailty is also associated with longer DtS.
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页码:3299 / 3309
页数:11
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