Impact of clinical frailty on surgical and non-surgical complications after major emergency abdominal surgery
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Impact of clinical frailty on surgical and non-surgical complications after major emergency abdominal surgery. / Snitkjær, Christian; Rehné Jensen, Lasse; Í Soylu, Liv; Hauge, Camilla; Kvist, Madeline; Jensen, Thomas K; Kokotovic, Dunja; Burcharth, Jakob.
I: BJS open, Bind 8, Nr. 3, 2024.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Impact of clinical frailty on surgical and non-surgical complications after major emergency abdominal surgery
AU - Snitkjær, Christian
AU - Rehné Jensen, Lasse
AU - Í Soylu, Liv
AU - Hauge, Camilla
AU - Kvist, Madeline
AU - Jensen, Thomas K
AU - Kokotovic, Dunja
AU - Burcharth, Jakob
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2024
Y1 - 2024
N2 - BACKGROUND: Major emergency abdominal surgery is associated with a high risk of morbidity and mortality. Given the ageing and increasingly frail population, understanding the impact of frailty on complication patterns after surgery is crucial. The aim of this study was to evaluate the association between clinical frailty and organ-specific postoperative complications after major emergency abdominal surgery.METHODS: A prospective cohort study including all patients undergoing major emergency abdominal surgery at Copenhagen University Hospital Herlev, Denmark, from 1 October 2020 to 1 August 2022, was performed. Clinical frailty scale scores were determined for all patients upon admission and patients were then analysed according to clinical frailty scale groups (scores of 1-3, 4-6, or 7-9). Postoperative complications were registered until discharge.RESULTS: A total of 520 patients were identified. Patients with a low clinical frailty scale score (1-3) experienced fewer total complications (120 complications per 100 patients) compared with patients with clinical frailty scale scores of 4-6 (250 complications per 100 patients) and 7-9 (277 complications per 100 patients) (P < 0.001). A high clinical frailty scale score was associated with a high risk of pneumonia (P = 0.009), delirium (P < 0.001), atrial fibrillation (P = 0.020), and infectious complications in general (P < 0.001). Patients with severe frailty (clinical frailty scale score of 7-9) suffered from more surgical complications (P = 0.001) compared with the rest of the cohort. Severe frailty was associated with a high risk of 30-day mortality (33% for patients with a clinical frailty scale score of 7-9 versus 3.6% for patients with a clinical frailty scale score of 1-3, P < 0.001). In a multivariate analysis, an increasing degree of clinical frailty was found to be significantly associated with developing at least one complication.CONCLUSION: Patients with frailty have a significantly increased risk of postoperative complications after major emergency abdominal surgery, especially atrial fibrillation, delirium, and pneumonia. Likewise, patients with frailty have an increased risk of mortality within 90 days. Thus, frailty is a significant predictor for adverse events after major emergency abdominal surgery and should be considered in all patients undergoing major emergency abdominal surgery.
AB - BACKGROUND: Major emergency abdominal surgery is associated with a high risk of morbidity and mortality. Given the ageing and increasingly frail population, understanding the impact of frailty on complication patterns after surgery is crucial. The aim of this study was to evaluate the association between clinical frailty and organ-specific postoperative complications after major emergency abdominal surgery.METHODS: A prospective cohort study including all patients undergoing major emergency abdominal surgery at Copenhagen University Hospital Herlev, Denmark, from 1 October 2020 to 1 August 2022, was performed. Clinical frailty scale scores were determined for all patients upon admission and patients were then analysed according to clinical frailty scale groups (scores of 1-3, 4-6, or 7-9). Postoperative complications were registered until discharge.RESULTS: A total of 520 patients were identified. Patients with a low clinical frailty scale score (1-3) experienced fewer total complications (120 complications per 100 patients) compared with patients with clinical frailty scale scores of 4-6 (250 complications per 100 patients) and 7-9 (277 complications per 100 patients) (P < 0.001). A high clinical frailty scale score was associated with a high risk of pneumonia (P = 0.009), delirium (P < 0.001), atrial fibrillation (P = 0.020), and infectious complications in general (P < 0.001). Patients with severe frailty (clinical frailty scale score of 7-9) suffered from more surgical complications (P = 0.001) compared with the rest of the cohort. Severe frailty was associated with a high risk of 30-day mortality (33% for patients with a clinical frailty scale score of 7-9 versus 3.6% for patients with a clinical frailty scale score of 1-3, P < 0.001). In a multivariate analysis, an increasing degree of clinical frailty was found to be significantly associated with developing at least one complication.CONCLUSION: Patients with frailty have a significantly increased risk of postoperative complications after major emergency abdominal surgery, especially atrial fibrillation, delirium, and pneumonia. Likewise, patients with frailty have an increased risk of mortality within 90 days. Thus, frailty is a significant predictor for adverse events after major emergency abdominal surgery and should be considered in all patients undergoing major emergency abdominal surgery.
KW - Humans
KW - Postoperative Complications/etiology
KW - Female
KW - Male
KW - Aged
KW - Frailty/complications
KW - Prospective Studies
KW - Denmark/epidemiology
KW - Abdomen/surgery
KW - Middle Aged
KW - Aged, 80 and over
KW - Risk Factors
KW - Pneumonia/epidemiology
KW - Delirium/etiology
KW - Frail Elderly
KW - Emergencies
KW - Geriatric Assessment
U2 - 10.1093/bjsopen/zrae039
DO - 10.1093/bjsopen/zrae039
M3 - Journal article
C2 - 38788680
VL - 8
JO - BJS open
JF - BJS open
SN - 2474-9842
IS - 3
ER -
ID: 394295099