ArticleJournal of the American Geriatrics Society2020
The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 62 citations in OpenAlex.
- Palliative prognostic tools in surgical patients at the end of life: a systematic review.British journal of anaesthesia · 2025Pooled it
- Frailty and Emergency Surgery: Results of a Systematic Review and Meta-Analysis.Frontiers in medicine · 2022Pooled it
- Frailty and low utilization of curative-intent surgical resection in nonmetastatic pancreatic cancer.JNCI cancer spectrum · 2026Article
- Patient Perceptions of Palliative Care in Surgery: A Qualitative Study.Journal of pain and symptom management · 2026Article
- Long-term survival in generalized peritonitis: the impact of early critical periods in major emergency abdominal surgery.BMC surgery · 2026Article
- Acute mesenteric ischemia in older adults: clinical profiles, management patterns, and outcomes in medical and surgical settings.European geriatric medicine · 2026Observational
- Association of Frailty and Perioperative Outcomes Across Surgical Specialties Between 2016 and 2018 Using the National Inpatient Sample Database: A Retrospective Cohort Study.Health science reports · 2026Article
- Comorbidity and Frailty Indices Predict Disposition in Head and Neck Free Flap Patients.Laryngoscope investigative otolaryngology · 2026Article
- The Role of the Clinical Frailty Scale in Stratifying Management of Older Adults with Acute Calculous Cholecystitis and Acute Gallstone Pancreatitis.International journal of general medicine · 2026Review
- Completion total pancreatectomy (CTP) for isolated PDAC recurrence.Bioinformation · 2026Article
- 'Am I ever going to get back to being how I was before?': the experience of emergency laparotomy for older people living with frailty.BMC geriatrics · 2025Article
- Review
- Top Ten Tips Palliative Care Clinicians Should Know Before Their Patient Undergoes Surgery.Journal of palliative medicine · 2025Article
- Days at home after surgery as a perioperative outcome: scoping review and recommendations for use in health services research.The British journal of surgery · 2024Article
- Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults.CNS neuroscience & therapeutics · 2024Article
- One-year mortality rates after standardized management for emergency laparotomy: results from the Swedish SMASH study.BJS open · 2024Article
- Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient.World journal of surgery · 2023Review
- A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial.JMIR formative research · 2023Article
- What If We Do Not Operate? Outcomes of Nonoperatively Managed Emergency General Surgery Patients.The Journal of surgical research · 2023Article
- Functional Status is Key to Long-term Survival in Emergency General Surgery Conditions.The Journal of surgical research · 2023Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesFew studies examine the impact of frailty on long-term patient-oriented outcomes after emergency general surgery (EGS). We measured the prevalence of frailty among older EGS patients and examined the impact of frailty on 1-year outcomes.
designRetrospective cohort study using 2008 to 2014 Medicare claims.
settingAcute care hospitals.
participantsPatients 65 years or older who received one of the five EGS procedures with the highest mortality burden (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy). MEASUREMENTS: A validated claims-based frailty index (CFI) identified patients who were not frail (CFI < .15), pre-frail (.15 ≤ CFI < .25), mildly frail (.25 ≤ CFI < .35), and moderately to severely frail (CFI ≥ .35). Multivariable Cox regression compared 1-year mortality. Multivariable Poisson regression compared rates of post-discharge hospital encounters (hospitalizations, intensive care unit stay, emergency department visit) and home time over 1 year after discharge. All regression models adjusted for age, sex, race, admission from facility, procedure, sepsis, inpatient palliative care delivery, trauma center designation, hospital bed size, and teaching status, and they were clustered by patient and hospital referral region.
resultsAmong 468 459 older EGS adults, 37.4% were pre-frail, 12.4% were mildly frail, and 3.6% were moderately to severely frail. Patients with mild frailty experienced a higher risk of 1-year mortality compared with non-frail patients (hazard ratio = 1.97; confidence interval [CI] = 1.94-2.01). In the year after discharge, patients with mild and moderate to severe frailty had more hospital encounters compared with non-frail patients (7.8 and 11.5 vs 2.0 per person-year; incidence rate ratio [IRR] = 4.01; CI = 3.93-4.08 vs IRR = 5.89; CI = 5.70-6.09, respectively). Patients with mild and moderate to severe frailty also had fewer days at home in the year after discharge compared with non-frail patients (256 and 203 vs 302 mean days; IRR = .97; CI = .96-.97 vs IRR = .95; CI = .94-.95, respectively).
conclusionOlder EGS patients with frailty are at increased risk for poor 1-year outcomes and decreased home time. Targeted interventions for older EGS patients with frailty during the index EGS hospitalization are urgently needed to improve long-term outcomes. J Am Geriatr Soc 68:1037-1043, 2020.
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