Frailty in older patients undergoing emergency colorectal surgery:USANational Surgical Quality Improvement Program analysis

Background Frailty is associated with advancing age and may result in adverse postoperative outcomes. A suspected growing elderly population needing emergency colorectal surgery stimulated this study of the prevalence and impact of frailty. Methods Elderly patients (defined as aged at least 65 years by Medicare and the United States Census Bureau) who underwent emergency colorectal resection between 2012 and 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program population database. The five-item modified frailty index (mFI-5) score was calculated, and patients stratified into groups 0, 1 or 2 + . Main outcome measures were the prevalence of frailty, and its impact on 30-day postoperative morbidity, mortality, reoperation, duration of hospital stay (LOS), discharge destination and readmission. Results A total of 10 025 patients were identified with a median age 75 years, of whom 41 center dot 8 per cent were men. The majority (87 center dot 7 per cent) had an ASA fitness grade of III or greater and 3129 (31 center dot 2 per cent) were frail (mFI-5 group 2+). Major morbidity occurred in one-third of patients and the postoperative mortality rate was 15 center dot 9 per cent. Some 52 center dot 0 per cent of patients had a prolonged hospital stay and 11 center dot 0 per cent were readmitted. Although most patients (88 center dot 0 per cent) lived independently before surgery, only 45 center dot 4 per cent were discharged home directly. Frailty (mFI-5 2+) predicted mortality, overall and major morbidity, reoperation, prolonged LOS, discharge to an institution and readmission, but frailty was independent of sex. Conclusion Frailty is associated with morbidity, mortality and loss of independence in elderly patients needing emergency colorectal surgery.