Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Abstract

BACKGROUND: Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.

METHODS: The ELF study was a UK-wide multicentre prospective cohort study of older patients (65?years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.

RESULTS: A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76á2(6á8) years, with 57á6 per cent women; 20á2 per cent were frail. Some 37á4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4á48 (95 per cent c.i. 2á03 to 9á91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5á94 (2á54 to 13á90) for those mildly frail (CFS 5) and 7á88 (2á97 to 20á79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.

CONCLUSION: Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.