Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy.
Aged
Aged, 80 and over
Comorbidity
Decision Making
Emergencies
Female
Follow-Up Studies
Frail Elderly
Frailty
/ epidemiology
Geriatric Assessment
/ methods
Humans
Laparotomy
/ methods
Length of Stay
Male
Patient Admission
/ trends
Patient Discharge
Prospective Studies
Risk Assessment
/ methods
Risk Factors
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
04
06
2019
revised:
20
07
2019
accepted:
12
09
2019
pubmed:
12
1
2020
medline:
28
10
2020
entrez:
12
1
2020
Statut:
ppublish
Résumé
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge. The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level. A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit. Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning. Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores (> 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia. La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.
Sections du résumé
BACKGROUND
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.
METHODS
The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.
RESULTS
A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.
CONCLUSION
Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.
ANTECEDENTES
Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores (> 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.
RESULTADOS
La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.
Autres résumés
Type: Publisher
(spa)
Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores (> 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
218-226Subventions
Organisme : Medical Research Council
ID : MR/S001751/1
Pays : United Kingdom
Investigateurs
Bryony Ross
(B)
Julia Oleksiewicz
(J)
Nicola Fearnhead
(N)
Christopher Jump
(C)
Jemma Boyle
(J)
Alex Shaw
(A)
Jonathan Barker
(J)
Jane Hughes
(J)
Jonathan Randall
(J)
Isileli Tonga
(I)
James Kynaston
(J)
Matthew Boal
(M)
Nicola Eardley
(N)
Elizabeth Kane
(E)
Harriet Reader
(H)
Sunanda Roy Mahapatra
(SR)
Michael Garner-Jones
(M)
Jessica Juliana Tan
(JJ)
Said Mohamed
(S)
Rina George
(R)
Ed Whiteman
(E)
Kamran Malik
(K)
Christopher J Smart
(CJ)
Monica Bogdan
(M)
Madhu Parna Chaudhury
(MP)
Videha Sharma
(V)
Daren Subar
(D)
Panna Patel
(P)
Sok-Moi Chok
(SM)
Evelyn Lim
(E)
Vedamurthy Adhiyaman
(V)
Glesni Davies
(G)
Ellen Ross
(E)
Rudra Maitra
(R)
Colin W Steele
(CW)
Campbell Roxburgh
(C)
Shelly Griffiths
(S)
Natalie S Blencowe
(NS)
Emily N Kirkham
(EN)
John S Abraham
(JS)
Kirsty Griffiths
(K)
Yasser Abdulaal
(Y)
Muhammad Rafaih Iqbal
(MR)
Munir Tarazi
(M)
James Hill
(J)
Azam Khan
(A)
Ian Farrell
(I)
Gemma Conn
(G)
Jugal Patel
(J)
Hyder Reddy
(H)
Janahan Sarveswaran
(J)
Lakshmanan Arunachalam
(L)
Afaq Malik
(A)
Luca Ponchietti
(L)
Krystian Pawelec
(K)
Yan Mei Goh
(YM)
Parveen Vitish-Sharma
(P)
Ahmed Saad
(A)
Edward Smyth
(E)
Amy Crees
(A)
Louise Merker
(L)
Nahida Bashir
(N)
Gethin Williams
(G)
Jennifer Hayes
(J)
Kelly Walters
(K)
Rhiannon Harries
(R)
Rahulpreet Singh
(R)
Nikola A Henderson
(NA)
Francesco M Polignano
(FM)
Ben Knight
(B)
Louise Alder
(L)
Alexandra Kenchington
(A)
Yan Li Goh
(YL)
Ilaria Dicurzio
(I)
Ewen Griffiths
(E)
Ahmed Alani
(A)
Katrina Knight
(K)
Patrick MacGoey
(P)
Guat Shi Ng
(GS)
Naomi Mackenzie
(N)
Ishaan Maitra
(I)
Susan Moug
(S)
Kelly Ong
(K)
Daniel McGrath
(D)
Emanuele Gammeri
(E)
Guillame Lafaurie
(G)
Gemma Faulkner
(G)
Gabriele Di Benedetto
(GD)
Julia McGovern
(J)
Bharathi Subramanian
(B)
Sunil Kumar Narang
(SK)
Jennifer Nowers
(J)
Neil J Smart
(NJ)
Ian R Daniels
(IR)
Massimo Varcada
(M)
Tanzeela Gala
(T)
Julie Cornish
(J)
Zoe Barber
(Z)
Stephen O'Neill
(S)
Richard McGregor
(R)
Andrew G Robertson
(AG)
Simon Paterson-Brown
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Thomas Raymond
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Mohamed A Thaha
(MA)
William J English
(WJ)
Cillian T Forde
(CT)
Heidi Paine
(H)
Alpa Morawala
(A)
Ravindra Date
(R)
Patrick Casey
(P)
Thomas Bolton
(T)
Xuan Gleaves
(X)
Joshua Fasuyi
(J)
Sanja Durakovic
(S)
Matt Dunstan
(M)
Sophie Allen
(S)
Angela Riga
(A)
Jonathan Epstein
(J)
Lyndsay Pearce
(L)
Emily Gaines
(E)
Anthony Howe
(A)
Halima Choonara
(H)
Ffion Dewi
(F)
Joanne Bennett
(J)
Emile King
(E)
Kathryn McCarthy
(K)
Greg Taylor
(G)
Dean Harris
(D)
Hari Nageswaran
(H)
Amy Stimpson
(A)
Kamran Siddiqui
(K)
Lay In Lim
(LI)
Christopher Ray
(C)
Laura Smith
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Gillian McColl
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Mohammed Rahman
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Aaron Kler
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Abhi Sharma
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Neil Patel
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Felix Nicholas
(F)
Thomas Marks
(T)
Cameron Abbott
(C)
Susan Chandler
(S)
Informations de copyright
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.
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