A Multi-Centre Prospective Snapshot Audit of Frailty amongst Emergency General Surgery Admissions

Abstract Background As the population ages, older patients with complex comorbidities are increasingly being admitted to hospitals with surgical pathology. Independent of age and comorbidities, frailty predicts mortality, complications, prolonged length of stay and loss of independence after hospitalisation. Understanding of the impact of frailty on unscheduled surgical care is needed to guide future service provision. This prospective collaborative study aimed to determine the prevalence of frailty amongst emergency general surgery admissions. Methods A multi-centre prospective snapshot audit was performed over a two-month period in eight Irish hospitals. For fourteen consecutive days, all emergency general surgery admissions >60 years was screened for frailty using the Clinical Frailty Score (CFS) by the on-call team. Details on demographics, comorbidities and lab data were recorded from the “Surgical Sign-Out” documents. Discharge summaries were subsequently reviewed, and 30-day outcomes documented. Results Across 112 call sessions in eight hospitals, 277 patients >60 years were admitted. Fifty-one percent were male and the mean age was 75.57 years (+/- SD 8.81). Fifty-two percent (n=135/258) of screened patients had a CFS ≥4. Frail patients had significantly higher rates of CCF (p<0.001), CKD (p=0.009), cognitive impairment (p<0.001), anticoagulation (p<0.001), polypharmacy (p<0.001) and anaemia (p=0.004). Frailty was associated was significantly higher rates of all complications (p<0.001) and cardiac complications (p=0.034). Frail patients required significantly more medical consults (p=0.009), MDT input (p<0.001) and home care package adjustment (p=0.019). At 30 days, frail patients were more likely to still be inpatients (p=0.018) and less likely to be discharged directly to home (p=0.004), with higher rates of inpatient mortality (p=0.033) and 30-day readmissions (p=0.020). Conclusion High levels of frailty were noted amongst emergency surgical admissions across Irish hospitals. Routine frailty screening and proactive specialist geriatric input may lead to improved outcomes in this high-risk cohort.