Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Issue 3 (10th January 2020)

• Record Type: Journal Article
• Authors: Carter, B.; Law, J.; Hewitt, J.; Parmar, K. L.; Boyle, J. M.; Casey, P.; Maitra, I.; Pearce, L.; Moug, S. J.
• Other Names: Ross Bryony investigator.; Oleksiewicz Julia investigator.; Fearnhead Nicola investigator.; Jump Christopher investigator.; Boyle Jemma investigator.; Shaw Alex investigator.; Barker Jonathan investigator.; Hughes Jane investigator.; Randall Jonathan investigator.; Tonga Isileli investigator.; Kynaston James investigator.; Boal Matthew investigator.; Eardley Nicola investigator.; Kane Elizabeth investigator.; Reader Harriet investigator.; Mahapatra Sunanda Roy investigator.; Garner-Jones Michael investigator.; Tan Jessica Juliana investigator.; Mohamed Said investigator.; George Rina investigator.; Whiteman Ed investigator.; Malik Kamran investigator.; Smart Christopher J investigator.; Bogdan Monica investigator.; Chaudhury Madhu Parna investigator.; Sharma Videha investigator.; Subar Daren investigator.; Patel Panna investigator.; Chok Sok-Moi investigator.; Lim Evelyn investigator.; Adhiyaman Vedamurthy investigator.; Davies Glesni investigator.; Ross Ellen investigator.; Maitra Rudra investigator.; Steele Colin W investigator.; Roxburgh Campbell investigator.; Griffiths Shelly investigator.; Blencowe Natalie S investigator.; Kirkham Emily N investigator.; Abraham John S investigator.; Griffiths Kirsty investigator.; Abdulaal Yasser investigator.; Iqbal Muhammad Rafaih investigator.; Tarazi Munir investigator.; Hill James investigator.; Khan Azam investigator.; Farrell Ian investigator.; Conn Gemma investigator.; Patel Jugal investigator.; Reddy Hyder investigator.; Sarveswaran Janahan investigator.; Arunachalam Lakshmanan investigator.; Malik Afaq investigator.; Ponchietti Luca investigator.; Pawelec Krystian investigator.; Goh Yan Mei investigator.; Vitish-Sharma Parveen investigator.; Saad Ahmed investigator.; Smyth Edward investigator.; Crees Amy investigator.; Merker Louise investigator.; Bashir Nahida investigator.; Williams Gethin investigator.; Hayes Jennifer investigator.; Walters Kelly investigator.; Harries Rhiannon investigator.; Singh Rahulpreet investigator.; Henderson Nikola A investigator.; Polignano Francesco M investigator.; Knight Ben investigator.; Alder Louise investigator.; Kenchington Alexandra investigator.; Goh Yan Li investigator.; Dicurzio Ilaria investigator.; Griffiths Ewen investigator.; Alani Ahmed investigator.; Knight Katrina investigator.; MacGoey Patrick investigator.; Ng Guat Shi investigator.; Mackenzie Naomi investigator.; Maitra Ishaan investigator.; Moug Susan investigator.; Ong Kelly investigator.; McGrath Daniel investigator.; Gammeri Emanuele investigator.; Lafaurie Guillame investigator.; Faulkner Gemma investigator.; Benedetto Gabriele Di investigator.; McGovern Julia investigator.; Subramanian Bharathi investigator.; Narang Sunil Kumar investigator.; Nowers Jennifer investigator.; Smart Neil J investigator.; Daniels Ian R investigator.; Varcada Massimo investigator.; Gala Tanzeela investigator.; Cornish Julie investigator.; Barber Zoe investigator.; O'Neill Stephen investigator.; McGregor Richard investigator.; Robertson Andrew G investigator.; Paterson-Brown Simon investigator.; Raymond Thomas investigator.; Thaha Mohamed A investigator.; English William J investigator.; Forde Cillian T investigator.; Paine Heidi investigator.; Morawala Alpa investigator.; Date Ravindra investigator.; Casey Patrick investigator.; Bolton Thomas investigator.; Gleaves Xuan investigator.; Fasuyi Joshua investigator.; Durakovic Sanja investigator.; Dunstan Matt investigator.; Allen Sophie investigator.; Riga Angela investigator.; Epstein Jonathan investigator.; Pearce Lyndsay investigator.; Gaines Emily investigator.; Howe Anthony investigator.; Choonara Halima investigator.; Dewi Ffion investigator.; Bennett Joanne investigator.; King Emile investigator.; McCarthy Kathryn investigator.; Taylor Greg investigator.; Harris Dean investigator.; Nageswaran Hari investigator.; Stimpson Amy investigator.; Siddiqui Kamran investigator.; Lim Lay In investigator.; Ray Christopher investigator.; Smith Laura investigator.; McColl Gillian investigator.; Rahman Mohammed investigator.; Kler Aaron investigator.; Sharma Abhi investigator.; Parmar Kat investigator.; Patel Neil investigator.; Crofts Perry investigator.; Baldari Claudio investigator.; Thomas Rhys investigator.; Stechman Michael investigator.; Aldridge Roland investigator.; O'Kelly James investigator.; Wilson Graeme investigator.; Gallegos Nicholas investigator.; Kalaiselvan Ramya investigator.; Rajaganeshan Rajasundaram investigator.; Mackenzie Aliya investigator.; Naik Prashant investigator.; Singh Kaushiki investigator.; Gandraspulli Harinath investigator.; Wilson Jeremy investigator.; Hancorn Kate investigator.; Khawaja Amir investigator.; Nicholas Felix investigator.; Marks Thomas investigator.; Abbott Cameron investigator.; Chandler Susan investigator.;
• Is Part Of: British journal of surgery. Volume 107:Issue 3(2020)
• Page Start: 218
• Page End: 226
• Publication Date: 2020-01-10
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11392
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract : Background: Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision‐making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge. Methods: The ELF study was a UK‐wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level. Results: A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit. Conclusion: Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision‐making and discharge planning. Abstract : This UK‐wide prospective cohort study of 934 patients (from 49 hospitals) aged 65 years or older undergoing emergency laparotomy found that increased frailty was associated with a reduction in independence at discharge, compared with admission care level. CFS, Clinical Frailty Score. Frailty predicts outcomes Abstract : Antecedentes: Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF ( Emergency Laparotomy and Frailty ) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. Métodos: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido ( n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores (> 65 años) sometidos a laparotomía de urgencia durante marzo‐junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia. Resultados: La edad media de los pacientes fue 76, 2 años (DE = 6, 83), con un 57% de mujeres, un 20, 2% de pacientes frágiles y un 37, 4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades ( odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4, 48 (i.c. del 95% 2, 03‐9, 91) para pacientes aparentemente vulnerables ( Clinical Frailty Scale, CFS 4); 5, 94 (i.c. del 95% 2, 54‐13, 90) para aquellos ligeramente frágiles (CFS 5); y 7, 88 (i.c. del 95% 2, 97‐20, 79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. Conclusión: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.