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Meta-Analysis
. 2022 Feb;48(1):141-151.
doi: 10.1007/s00068-020-01578-9. Epub 2021 Jan 9.

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Christophe Alain Fehlmann  1   2   3 , Dilan Patel  4   5 , Jessica McCallum  4   5   6 , Jeffrey Joseph Perry  4   5   6 , Debra Eagles  4   5   6
Affiliations
Meta-Analysis

Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis

Christophe Alain Fehlmann et al. Eur J Trauma Emerg Surg. 2022 Feb.

Abstract

Purpose: The purpose of this review was to determine the association between frailty and mortality among adults ≥ 65 years old undergoing emergency general surgery (EGS).

Methods: This systematic review followed the PRISMA guidelines (CRD42020172482 on PROSPERO). A search in MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews was conducted from inception to March 5, 2020. Studies with patients ≥ 65 years undergoing EGS were included. The primary exposure was frailty, measured using the Clinical Frailty Scale or the Modified Frailty Index. The primary outcome was 30-day mortality. Secondary outcomes were 90-day and 1-year mortality, length of stay, complications, change in level of care at discharge, and loss of independence. Two independent reviewers screened articles and extracted data. Risk of bias was assessed according to the Newcastle-Ottawa Scale and quality of evidence was assessed using the GRADE approach. A meta-analysis was performed for 30-day mortality using a random-effects model.

Results: Our search yielded 847 articles and six cohort studies were included in the systematic review. There were 1289 patients, 283 being frail. The pooled OR from meta-analysis for frail compared to non-frail patients was 2.91 (95% CI 2.00, 4.23) for 30-day mortality. Frailty was associated with increased odds of all secondary outcomes.

Conclusion: Frailty is significantly associated with worse outcomes after emergency general surgery in adults ≥ 65 years of age. The Clinical Frailty Scale could be used to improve preoperative risk assessment for patients and shared decision-making between patients and healthcare providers.

Registration number: CRD42020172482 (PROSPERO).

Keywords: Clinical frailty scale; Emergency general surgery; Frailty; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of search strategy and studies selection
Fig. 2
Fig. 2
Forest plot for unadjusted OR of 30-day mortality in older patients undergoing emergency general surgery
See this image and copyright information in PMC

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