The association between pre-admission frailty and care level at discharge in Older adults undergoing Emergency Laparotomy.

TY - JOUR

T1 - The association between pre-admission frailty and care level at discharge in Older adults undergoing Emergency Laparotomy.

AU - Carter, Benjamin Richard

AU - Law, Jennifer

AU - Hewitt, Jonathan

AU - Palmer, Kat

AU - Boyle, Jemma

AU - Casey, Patrick

AU - Maitra, Ishaan

AU - Pearce, Lyndsay

AU - Moug, Susan J

AU - ELF STUDY, null

PY - 2019/9/12

Y1 - 2019/9/12

N2 - Abstract Introduction Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those that survive, the level of care required upon discharge from hospital is unknown and such information could guide decision-making. The ELF Study (Emergency Laparotomy and Frailty) aimed to determine if pre-operative frailty in older adults was associated with increased dependence at the time of discharge. Methods The ELF study was a UK wide multicenter (n=49), prospective cohort study of 934 older patients (>65 years) undergoing emergency laparotomy during March-June 2017. The objective was to establish if pre-operative frailty increased care level at discharge, compared to pre-operative care. The analysis used a multi-level logistic regression adjusted for pre-admission: frailty; patient age; gender; and care-level. Results The mean patient age was 76.2 years (SD=6.83), with 57% female, 20.2% frail, and 37.4% of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level (and greater predictive power than age). The aOR for an increase in care level was 4.48 (95% CI 2.03-9.91) for apparently vulnerable patients (CFS 4); 5.94 (95% CI 2.54-13.90) for those mildly frail (CFS 5); and 7.88 (95% CI 2.97-20.79) for those moderately or severely frail, (CFS 6 and 7) compared to patients who were fit. Conclusions This is the first study to document that over 37% of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring should be integrated into all acute surgical units to aid shared decision-making and treatment planning.

AB - Abstract Introduction Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those that survive, the level of care required upon discharge from hospital is unknown and such information could guide decision-making. The ELF Study (Emergency Laparotomy and Frailty) aimed to determine if pre-operative frailty in older adults was associated with increased dependence at the time of discharge. Methods The ELF study was a UK wide multicenter (n=49), prospective cohort study of 934 older patients (>65 years) undergoing emergency laparotomy during March-June 2017. The objective was to establish if pre-operative frailty increased care level at discharge, compared to pre-operative care. The analysis used a multi-level logistic regression adjusted for pre-admission: frailty; patient age; gender; and care-level. Results The mean patient age was 76.2 years (SD=6.83), with 57% female, 20.2% frail, and 37.4% of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level (and greater predictive power than age). The aOR for an increase in care level was 4.48 (95% CI 2.03-9.91) for apparently vulnerable patients (CFS 4); 5.94 (95% CI 2.54-13.90) for those mildly frail (CFS 5); and 7.88 (95% CI 2.97-20.79) for those moderately or severely frail, (CFS 6 and 7) compared to patients who were fit. Conclusions This is the first study to document that over 37% of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring should be integrated into all acute surgical units to aid shared decision-making and treatment planning.

KW - Emergency Laparotomy

KW - frailty

KW - older persons

KW - discharge care

M3 - Article

SN - 0007-1323

JO - The British journal of surgery

JF - The British journal of surgery

ER -