The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery.
Emergency surgery
Frailty
Predictive tool
Procedure-specific morbidity
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
29
05
2020
accepted:
03
10
2020
pubmed:
19
11
2020
medline:
28
7
2021
entrez:
18
11
2020
Statut:
ppublish
Résumé
Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called "EmSFI". Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654-0.772]; HL test χ The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.
Sections du résumé
BACKGROUND
BACKGROUND
Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery.
STUDY DESIGN
METHODS
1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called "EmSFI". Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score.
RESULTS
RESULTS
784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654-0.772]; HL test χ
CONCLUSIONS
CONCLUSIONS
The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.
Identifiants
pubmed: 33205380
doi: 10.1007/s40520-020-01735-5
pii: 10.1007/s40520-020-01735-5
pmc: PMC8302529
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2191-2201Investigateurs
F Agresta
(F)
G Alemanno
(G)
G Anania
(G)
M Antropoli
(M)
G Argenio
(G)
J Atzeni
(J)
N Avenia
(N)
A Azzinnaro
(A)
G Baldazzi
(G)
G Balducci
(G)
G Barbera
(G)
G Bellanova
(G)
C Bergamini
(C)
L Bersigotti
(L)
P P Bianchi
(PP)
C Bombardini
(C)
G Borzellino
(G)
S Bozzo
(S)
G Brachini
(G)
G M Buonanno
(GM)
T Canini
(T)
S Cardella
(S)
G Carrara
(G)
D Cassini
(D)
M Castriconi
(M)
G Ceccarelli
(G)
D Celi
(D)
M Ceresoli
(M)
M Chiarugi
(M)
N Cillara
(N)
F Cimino
(F)
L Cobuccio
(L)
G Cocorullo
(G)
E Colangelo
(E)
G Costa
(G)
A Crucitti
(A)
P Dalla Caneva
(P)
M De Luca
(M)
A de Manzoni Garberini
(A)
C De Nisco
(C)
M De Prizio
(M)
A De Sol
(A)
A Dibella
(A)
T Falcioni
(T)
N Falco
(N)
C Farina
(C)
E Finotti
(E)
T Fontana
(T)
G Francioni
(G)
P Fransvea
(P)
B Frezza
(B)
G Garbarino
(G)
G Garulli
(G)
M Genna
(M)
S Giannessi
(S)
A Gioffrè
(A)
A Giordano
(A)
D Gozzo
(D)
S Grimaldi
(S)
G Gulotta
(G)
V Iacopini
(V)
T Iarussi
(T)
G Laracca
(G)
E Laterza
(E)
A Leonardi
(A)
L Lepre
(L)
L Lorenzon
(L)
G Luridiana
(G)
A Malagnino
(A)
G Mar
(G)
P Marini
(P)
R Marzaioli
(R)
G Massa
(G)
V Mecarelli
(V)
P Mercantini
(P)
A Mingoli
(A)
G Nigri
(G)
S Occhionorelli
(S)
N Paderno
(N)
G M Palini
(GM)
D Paradies
(D)
M Paroli
(M)
F Perrone
(F)
N Petrucciani
(N)
L Petruzzelli
(L)
A Pezzolla
(A)
D Piazza
(D)
V Piazza
(V)
M Piccoli
(M)
A Pisanu
(A)
M Podda
(M)
G Poillucci
(G)
R Porfidia
(R)
G Rossi
(G)
P Ruscelli
(P)
A Spagnoli
(A)
R Sulis
(R)
D Tartaglia
(D)
C Tranà
(C)
A Travaglino
(A)
P Tomaiuolo
(P)
A Valeri
(A)
G Vasquez
(G)
M Zago
(M)
E Zanoni
(E)
Informations de copyright
© 2020. The Author(s).
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