T.O. Jokar, K. Ibraheem, P. Rhee, N. Kulavatunyou, A. Haider, H. Phelan, M. Fain, M.J. Mohler, B. Joseph

J Trauma Acute Care Surg. 2016;81(2):254-60

Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in surgical cases. The aim of our study was to validate a modified 15 variable emergency general surgery specific frailty index (EGSFI).

We prospectively collected geriatric (age > 65) emergency general surgery patients for 1-year. Post-operative complications were collected. Frailty Index was calculated for 200 patients based on their pre-admission condition using 50-variable modified Rockwood Frailty Index (FI). EGSFI was developed based on the regression model for complications and the most significant factors in the FI. ROC curve analysis was performed to determine cutoff for frail status. We validated our results using 60 patients for predicting complications.

A total of 260 patients (200 developing, 60 Validation) were enrolled in this study. Mean age was 71 ± 11 years, and 33% developed complications. Most common complications were pneumonia (12%), UTI (9%), and wound infection (7%). Univariate analysis identified 15 variables significantly associated with complications that were used to develop the EGSFI. A cutoff frailty score of 0.325 was identified using ROC curve analysis for frail status. Sixty-patients (frail: 18, non-frail: 42) were enrolled in the validation cohort. Frail patients were more likely to have post-operative complications (47% vs. 20%, p < 0.001) compared to nonfrail patients. Frail status based on EGSFI was a significant predictor of post-operative complications (OR=7.3, 95%CI = 1.7 - 19.8; p=0.006). Age was not associated with postoperative complications (OR=0.99, 95%CI = 0.92 -1.06; p=0.86).