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. 2025 Apr 25;20(1):37.
doi: 10.1186/s13017-025-00612-8.

Changes in frailty status and discharge destination post emergency laparotomy

Hwei Jene Ng  1   2 , Nicholas J W Rattray  3 , Tara Quasim  4   5 , Susan J Moug  6   4   7
Affiliations

Changes in frailty status and discharge destination post emergency laparotomy

Hwei Jene Ng et al. World J Emerg Surg. .

Abstract

Background: Pre-operative frailty adversely affects morbidity and mortality after emergency laparotomy (EmLap), especially in older adults (65 years and above). Little is known about frailty after EmLap. We explored the change in frailty status from pre- to post-EmLap and any influence on discharge destination.

Methods: EmLap patients aged ≥ 65years from an acute surgical site were recruited from May 2022 to April 2023. Prospective data collection included demographics, frailty, mortality and discharge destination. Frailty was assessed using the Rockwood Clinical Frailty Scale at pre-EmLap and day-90 post-EmLap (< 4 as non-frail, 4 as pre-frail and > 4 as frail). EmLap patients with no 90-day follow-up were excluded. A p-value of < 0.05 was considered significant.

Results: 63 EmLap patients were included in the study. The median age was 75 years (range 65-91 years) with 36 (57.1%) females. Eleven (17.5%) were living with frailty pre-EmLap, and 10 (15.9%) developed new frailty by day-90 post-EmLap. Pre-EmLap, all patients came from home with 20.6% of the frail and pre-frail group having a package of care service (POC) in place. On 90-day post-EmLap, 1 was still an inpatient but 25.8% had a change in discharge destination: care home (n = 1), home with new POC (n = 2) and home with increased POC (n = 13). Of the 16 patients with change of discharge destination, 9 (56.3%) were frail pre-EmLap. There was a significant association between pre-EmLap frailty and change in home circumstances on discharge (p < 0.00001).

Conclusions: Emergency surgery can increase a patient's frailty status and significantly increases care requirements and social support after hospital discharge. Frailty assessment needs to be performed before and after admission in all EmLap patients to improve post-EmLap care planning and patient expectations.

Trial registration: ClinicalTrials.gov NCT05416047.

Keywords: Discharge destination; Emergency laparotomy; Frailty.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: The ethical approval for this study was obtained from Scotland A Research Ethics Committee (IRAS 293392) on 28.04.2022. Consent for publication: Not applicable. Further information: The abstract was submitted and presented as oral presentation in the Association of Surgeons of Great Britain and Ireland Conference 2024. DOI: 10.1093/bjs/znae197.100. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The Sankey chart showing changes in patients’ (n = 62) frailty status at pre- and post-EmLap and home environment after discharge
Fig. 2
Fig. 2
The receiver operating characteristic (ROC) curve analysis demonstrated that the Clinical Frailty Scale had good discriminatory ability in predicting post-operative discharge destination changes
See this image and copyright information in PMC

References

    1. Office for National Statistics U. Resident population projection of people in the United Kingdom (UK) for 2020 to 2050, by age group* (in 1,000s) 2019 [Available from: https://www.statista.com/statistics/749078/elderly-population-of-the-uk-...
    1. NELA. The ninth patient report of the National emergency laparotomy audit. Royal College of Anaesthetists (RCoA); 2024.
    1. ELLSA. The Second National Report of the Emergency Laparoscopic and Laparotomy Scottish Audit (ELLSA) 2023 [Available from: https://learn.nes.nhs.scot/74354
    1. Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15. - PMC - PubMed
    1. Rockwood K, Song X, Mitnitski A. Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National population health survey. Can Med Assoc J. 2011;183(8):e487–94. - PMC - PubMed

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