Frailty and Emergency Surgery: Results of a Systematic Review and Meta-Analysis

Tamas Leiner; David Nemeth; Peter Hegyi; Klementina Ocskay; Marcell Virag; Szabolcs Kiss; Mate Rottler; Matyas Vajda; Alex Varadi; Zsolt Molnar

doi:10.3389/fmed.2022.811524

Frailty and Emergency Surgery: Results of a Systematic Review and Meta-Analysis

Front Med (Lausanne). 2022 Mar 31:9:811524. doi: 10.3389/fmed.2022.811524. eCollection 2022.

Authors

Tamas Leiner^{1

2}, David Nemeth¹, Peter Hegyi^{1

3

4}, Klementina Ocskay^{1

3}, Marcell Virag^{1

5

6}, Szabolcs Kiss^{1

5}, Mate Rottler^{1

5

6}, Matyas Vajda^{1

5}, Alex Varadi¹, Zsolt Molnar^{1

3

7

8}

Affiliations

¹ Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary.
² Anaesthetic Department, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon, United Kingdom.
³ Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
⁴ Division for Pancreatic Disorders, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
⁵ Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
⁶ Department of Anesthesiology and Intensive Therapy, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary.
⁷ Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland.
⁸ Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.

Abstract

Background: Frailty, a "syndrome of loss of reserves," is a decade old concept. Initially it was used mainly in geriatrics but lately its use has been extended into other specialties including surgery. Our main objective was to examine the association between frailty and mortality, between frailty and length of hospital stay (LOS) and frailty and readmission within 30 days in the emergency surgical population.

Methods: Studies reporting on frailty in the emergency surgical population were eligible. MEDLINE (via PubMed), EMBASE, Scopus, CENTRAL, and Web of Science were searched with terms related to acute surgery and frail^*. We searched for eligible articles without any restrictions on the 2nd of November 2020. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI), using a random effect model. Risk of bias assessment was performed according to the recommendations of the Cochrane Collaboration. As the finally selected studies were either prospective or retrospective cohorts, the "Quality In Prognosis Studies" (QUIPS) tool was used.

Results: At the end of the selection process 21 eligible studies with total 562.070 participants from 8 countries were included in the qualitative and the quantitative synthesis. Patients living with frailty have higher chance of dying within 30 days after an emergency surgical admission (OR: 1.99; CI: 1.76-2.21; p < 0.001). We found a tendency of increased LOS with frailty in acute surgical patients (WMD: 4.75 days; CI: 1.79-7.71; p = 0.002). Patients living with frailty have increased chance of 30-day readmission after discharge (OR: 1.36; CI: 1.06-1.75; p = 0.015).

Conclusions: Although there is good evidence that living with frailty increases the chance of unfavorable outcomes, further research needs to be done to assess the benefits and costs of frailty screening for emergency surgical patients.

Systematic review registration: The review protocol was registered on the PROSPERO International Prospective Register of Systematic Reviews (CRD42021224689).

Keywords: Clinical Frailty Scale; emergency surgery; frail adults; meta-analysis; mortality.

Publication types

Systematic Review