학술논문
Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy
Document Type
Clinical report
Author
Carter, B.; Law, J.; Hewitt, J.; Parmar, K. L.; Boyle, J. M.; Casey, P.; Maitra, I.; Pearce, L.; Moug, S. J.; Ross, Bryony; Oleksiewicz, Julia; Fearnhead, Nicola; Jump, Christopher; Boyle, Jemma; Shaw, Alex; Barker, Jonathan; Hughes, Jane; Randall, Jonathan; Tonga, Isileli; Kynaston, James; Boal, Matthew; Eardley, Nicola; Kane, Elizabeth; Reader, Harriet; Mahapatra, Sunanda Roy; Garner-Jones, Michael; Tan, Jessica Juliana; Mohamed, Said; George, Rina; Whiteman, Ed; Malik, Kamran; Smart, Christopher J; Bogdan, Monica; Chaudhuryu Parna; Sharma, Videha; Subar, Daren; Patel, Panna; Chok, Sok-Moi; Lim, Evelyn; Adhiyaman, Vedamurthy; Davies, Glesni; Ross, Ellen; Maitra, Rudra; Steele, Colin W; Roxburgh, Campbell; Griffiths, Shelly; Blencowe, Natalie S; Kirkham, Emily N; Abraham, John S; Griffiths, Kirsty; Abdulaal, Yasser; Iqbal, Muhammad Rafaih; Tarazi, Munir; Hill, James; Khan, Azam; Farrell, Ian; Conn, Gemma; Patel, Jugal; Reddy, Hyder; Sarveswaran, Janahan; Arunachalam, Lakshmanan; Malik, Afaq; Ponchietti, Luca; Pawelec, Krystian; Goh, Yan Mei; Vitish-Sharma, Parveen; Saad, Ahmed; Smyth, Edward; Crees, Amy; Merker, Louise; Bashir, Nahida; Williams, Gethin; Hayes, Jennifer; Walters, Kelly; Harries, Rhiannon; Singh, Rahulpreet; Henderson, Nikola A; Polignano, Francesco M; Knight, Ben; Alder, Louise; Kenchington, Alexandra; Goh, Yan Li; Dicurzio, Ilaria; Griffiths, Ewen; Alani, Ahmed; Knight, Katrina; MacGoey, Patrick; Ng, Guat Shi; Mackenzie, Naomi; Maitra, Ishaan; Moug, Susan; Ong, Kelly; McGrath, Daniel; Gammeri, Emanuele; Lafaurie, Guillame; Faulkner, Gemma; Benedetto, Gabriele Di; McGovern, Julia; Subramanian, Bharathi; Narang, Sunil Kumar; Nowers, Jennifer; Smart, Neil J; Daniels, Ian R; Varcada, Massimo; Gala, Tanzeela; Cornish, Julie; Barber, Zoe; O'Neill, Stephen; McGregor, Richard; Robertson, Andrew G; Paterson-Brown, Simon; Raymond, Thomas; Thaha, Mohamed A; English, William J; Forde, Cillian T; Paine, Heidi; Morawala, Alpa; Date, Ravindra; Casey, Patrick; Bolton, Thomas; Gleaves, Xuan; Fasuyi, Joshua; Durakovic, Sanja; Dunstan, Matt; Allen, Sophie; Riga, Angela; Epstein, Jonathan; Pearce, Lyndsay; Gaines, Emily; Howe, Anthony; Choonara, Halima; Dewi, Ffion; Bennett, Joanne; King, Emile; McCarthy, Kathryn; Taylor, Greg; Harris, Dean; Nageswaran, Hari; Stimpson, Amy; Siddiqui, Kamran; Lim, Lay In; Ray, Christopher; Smith, Laura; McColl, Gillian; Rahman, Mohammed; Kler, Aaron; Sharma, Abhi; Parmar, Kat; Patel, Neil; Crofts, Perry; Baldari, Claudio; Thomas, Rhys; Stechman, Michael; Aldridge, Roland; O'Kelly, James; Wilson, Graeme; Gallegos, Nicholas; Kalaiselvan, Ramya; Rajaganeshan, Rajasundaram; Mackenzie, Aliya; Naik, Prashant; Singh, Kaushiki; Gandraspulli, Harinath; Wilson, Jeremy; Hancorn, Kate; Khawaja, Amir; Nicholas, Felix; Marks, Thomas; Abbott, Cameron; Chandler, Susan
Source
British Journal of Surgery. Feb 2020, Vol. 107 Issue 3, p218, 9 p.
Subject
Language
English
ISSN
0007-1323
Abstract
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 (65years 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. CAPTION(S): Appendix S1. Supporting information Byline: B. Carter, J. Law,J. Hewitt, K. L. Parmar, J. M. Boyle, P. Casey, I. Maitra, L. Pearce,S. J. Moug, , Bryony Ross, Julia Oleksiewicz, Nicola Fearnhead, Christopher Jump, Jemma Boyle, Alex Shaw, Jonathan Barker, Jane Hughes, Jonathan Randall, Isileli Tonga, James Kynaston, Matthew Boal, Nicola Eardley, Elizabeth Kane, Harriet Reader, Sunanda Roy Mahapatra, Michael Garner-Jones, Jessica Juliana Tan, Said Mohamed, Rina George, Ed Whiteman, Kamran Malik, Christopher J Smart, Monica Bogdan, Madhu Parna Chaudhury, Videha Sharma, Daren Subar, Panna Patel, Sok-Moi Chok, Evelyn Lim, Vedamurthy Adhiyaman, Glesni Davies, Ellen Ross, Rudra Maitra, Colin W Steele, Campbell Roxburgh, Shelly Griffiths, Natalie S Blencowe, Emily N Kirkham, John S Abraham, Kirsty Griffiths, Yasser Abdulaal, Muhammad Rafaih Iqbal, Munir Tarazi, James Hill, Azam Khan, Ian Farrell, Gemma Conn, Jugal Patel, Hyder Reddy, Janahan Sarveswaran, Lakshmanan Arunachalam, Afaq Malik, Luca Ponchietti, Krystian Pawelec, Yan Mei Goh, Parveen Vitish-Sharma, Ahmed Saad, Edward Smyth, Amy Crees, Louise Merker, Nahida Bashir, Gethin Williams, Jennifer Hayes, Kelly Walters, Rhiannon Harries, Rahulpreet Singh, Nikola A Henderson, Francesco M Polignano, Ben Knight, Louise Alder, Alexandra Kenchington, Yan Li Goh, Ilaria Dicurzio, Ewen Griffiths, Ahmed Alani, Katrina Knight, Patrick MacGoey, Guat Shi Ng, Naomi Mackenzie, Ishaan Maitra, Susan Moug, Kelly Ong, Daniel McGrath, Emanuele Gammeri, Guillame Lafaurie, Gemma Faulkner, Gabriele Di Benedetto, Julia McGovern, Bharathi Subramanian, Sunil Kumar Narang, Jennifer Nowers, Neil J Smart, Ian R Daniels, Massimo Varcada, Tanzeela Gala, Julie Cornish, Zoe Barber, Stephen O'Neill, Richard McGregor, Andrew G Robertson, Simon Paterson-Brown, Thomas Raymond, Mohamed A Thaha, William J English, Cillian T Forde, Heidi Paine, Alpa Morawala, Ravindra Date, Patrick Casey, Thomas Bolton, Xuan Gleaves, Joshua Fasuyi, Sanja Durakovic, Matt Dunstan, Sophie Allen, Angela Riga, Jonathan Epstein, Lyndsay Pearce, Emily Gaines, Anthony Howe, Halima Choonara, Ffion Dewi, Joanne Bennett, Emile King, Kathryn McCarthy, Greg Taylor, Dean Harris, Hari Nageswaran, Amy Stimpson, Kamran Siddiqui, Lay In Lim, Christopher Ray, Laura Smith, Gillian McColl, Mohammed Rahman, Aaron Kler, Abhi Sharma, Kat Parmar, Neil Patel, Perry Crofts, Claudio Baldari, Rhys Thomas, Michael Stechman, Roland Aldridge, James O'Kelly, Graeme Wilson, Nicholas Gallegos, Ramya Kalaiselvan, Rajasundaram Rajaganeshan, Aliya Mackenzie, Prashant Naik, Kaushiki Singh, Harinath Gandraspulli, Jeremy Wilson, Kate Hancorn, Amir Khawaja, Felix Nicholas, Thomas Marks, Cameron Abbott, Susan Chandler