Prevalence and outcomes of frailty in emergency laparotomy: a single-centre cohort study

Frailty is common among patients undergoing emergency laparotomy and is associated with adverse postoperative outcomes, yet routine frailty assessment remains inconsistently implemented despite international guideline recommendations. This study evaluates the prevalence of frailty using three rapid assessment tools and examines their associations with postoperative outcomes following emergency laparotomy. We conducted a single-centre retrospective cohort study of adults undergoing open emergency laparotomy over a 12-month period. Frailty was assessed retrospectively using the Clinical Frailty Scale (CFS ≥ 5), Emergency Surgery Frailty Index (EmSFI ≥ 7), and five-item Modified Frailty Index (mFI-5 ≥ 2). Primary outcomes were 30- and 90-day mortality. Secondary outcomes included postoperative complications, ICU admission, hospital length of stay, and discharge destination. Unadjusted analyses were descriptive. Multivariable logistic regression models were constructed with frailty measures specified as the primary exposures and adjusted for age, sex, operative indication, and anaesthetist-assigned ASA grade. Among 102 patients (median age 67 years, IQR 54–79; 53% female), frailty prevalence was 26% by CFS, 24% by EmSFI, and 27% by mFI-5, with 37% meeting at least one frailty threshold. In unadjusted analyses, patients living with frailty experienced higher rates of postoperative complications, ICU admission, longer hospital stay, and reduced likelihood of independent discharge home. After adjustment, frailty thresholds were not independently associated with 30- or 90-day mortality, while mFI-5–defined frailty was independently associated with ICU admission. Frailty assessment in emergency laparotomy identifies patients at increased risk of postoperative morbidity, ICU utilisation, and discharge dependence but does not independently predict short-term mortality after adjustment for key clinical factors.