Estimating the effect of frailty on longer-term survival following emergency laparotomy: an observational study using National Emergency Laparotomy Audit data.

Abstract

Approximately 30,000 emergency laparotomies are performed each year across the UK. Over half are in patients aged ≥ 65 y, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but the longer-term mortality risk has been studied less extensively, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on both short- (≤ 90 days) and longer-term (> 90 days) mortality following emergency laparotomy. A retrospective analysis of prospectively collected National Emergency Laparotomy Audit data was undertaken. Baseline patient characteristics including Clinical Frailty Scale (CFS) are collected routinely by the National Emergency Laparotomy Audit, and data are linked via NHS Digital with Office for National Statistics mortality data. Frailty was associated strongly with the hazard of death in the first 90 days after surgery. This association persisted beyond 90 days, albeit slightly weakened. Compared with CFS 1-3, adjusted hazard ratio estimates for survival from 90 days post-surgery increased from 1.52 (95%CI 1.41-1.64) for CFS 4; 1.69 (95%CI 1.57-1.82) for CFS 5; 2.14 (95%CI 1.98-2.31) for CFS 6; 2.97 (95%CI 2.59-3.41) for CFS 7; 4.24 (95%CI 3.19-5.64) for CFS 8; and 3.34 (95%CI 2.17-5.14) for CFS 9. For older people living with frailty, increased risk of death persists further than the immediate postoperative period. Our findings highlight the importance of identifying frailty within emergency laparotomy care. Further work should explore the holistic implications of surgery to identify how to mitigate this risk.