Assessing the impact of frailty in elderly patients undergoing emergency laparotomies in Singapore

Ann Acad Med Singap. 2024 Jun 28;53(6):352-360. doi: 10.47102/annals-acadmedsg.2023155.


Introduction: The global rise in ageing populations poses challenges for healthcare systems. By 2030, Singapore anticipates a quarter of its population to be aged 65 or older. This study addresses the dearth of research on frailty's impact on emergency laparotomy (EL) outcomes in this demographic, emphasising the growing significance of this surgical intervention.

Method: Conducted at 2 tertiary centres in Singapore from January to December 2019, a retrospective cohort study examined EL outcomes in patients aged 65 or older. Frailty assessment, using the Clinical Frailty Scale (CFS), was integrated into demographic, diagnostic and procedural analyses. Patient data from Tan Tock Seng Hospital and Khoo Teck Puat Hospital provided a comprehensive view of frailty's role in EL.

Results: Among 233 participants, 26% were frail, revealing a higher vulnerability in the geriatric population. Frail individuals exhibited elevated preoperative risk, prolonged ICU stays, and significantly higher 90-day mortality (21.3% versus 6.4%). The study illuminated a nuanced connection between frailty and adverse outcomes, underlining the critical need for robust predictive tools in this context.

Conclusion: Frailty emerged as a pivotal factor influencing the postoperative trajectory of older adults undergoing EL in Singapore. The integration of frailty assessment, particularly when combined with established metrics like P-POSSUM, showcased enhanced predictive accuracy. This finding offers valuable insights for shared decision-making and acute surgical unit practices, emphasising the imperative of considering frailty in the management of older patients undergoing emergency laparotomy.

Keywords: emergency surgery; frailty; general surgery; geriatric medicine; surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Emergencies
  • Female
  • Frail Elderly* / statistics & numerical data
  • Frailty* / epidemiology
  • Geriatric Assessment* / methods
  • Humans
  • Laparotomy* / methods
  • Laparotomy* / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Singapore / epidemiology