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Emergency general surgery specific frailty index: A validation study

Orouji Jokar, Tahereh MD; Ibraheem, Kareem MD; Rhee, Peter MD, MPH; Kulavatunyou, Narong MD; Haider, Ansab MD; Phelan, Herb A. MD; Fain, Mindy MD; Mohler, Martha Jane PHD, MPH; Joseph, Bellal MD

Journal of Trauma and Acute Care Surgery: August 2016 - Volume 81 - Issue 2 - p 254–260
doi: 10.1097/TA.0000000000001120
EAST 2016 Plenary Papers

INTRODUCTION Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in surgical cases. The aim of our study was to validate a modified 15-variable EGS-specific frailty index (EGSFI).

METHODS We prospectively collected geriatric (age older than 65 years) EGS patients for 2 years. Postoperative complications were collected. Frailty index was calculated for 200 patients based on their preadmission condition using 50-variable modified Rockwood frailty index. Emergency general surgery–specific frailty index was developed based on the regression model for complications and the most significant factors in the frailty index. Receiver operating characteristic curve analysis was performed to determine cutoff for frail status. We validated our results using 60 patients for predicting complications.

RESULTS A total of 260 patients (developing, 200; validation, 60) were enrolled in this study. Mean age was 71 ± 11 years, and 33% developed complications. Most common complications were pneumonia (12%), urinary tract infection (9%), and wound infection (7%). Univariate analysis identified 15 variables significantly associated with complications that were used to develop the EGSFI. A cutoff frailty score of 0.325 was identified using receiver operating characteristic curve analysis for frail status. Sixty patients (frail, 18; nonfrail, 42) were enrolled in the validation cohort. Frail patients were more likely to have postoperative complications (47% vs. 20%; p < 0.001) compared to nonfrail patients. Frail status based on EGSFI was a significant predictor of postoperative complications (odds ratio, 7.3; 95% confidence interval, 1.7–19.8; p = 0.006). Age was not associated with postoperative complications (odds ratio, 0.99; 95% confidence interval, 0.92–1.06; p = 0.86).

CONCLUSION The 15-variable validated EGSFI is a simple and reliable bedside tool to determine the frailty status of patients undergoing EGS. Frail status as determined by the EGSFI is an independent predictor of postoperative complications and mortality in geriatric EGS patients.

LEVEL OF EVIDENCE Prognostic study, level II.

From the Division of Trauma, Critical Care, Burns and Emergency Surgery, Department of Surgery (T.O.J., K.I., P.R., N.K., A.H., M.F., M.J.M., B.J.), University of Arizona, Tucson, Arizona; and Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery (H.A.P.), University of Texas Southwestern Medical Center, Dallas, Texas.

Submitted: December 3, 2015, Revised: March 15, 2016, Accepted: March 28, 2016, Published online: May 27, 2016.

This study was presented at the 29th annual meeting of the Eastern Association for the Surgery of Trauma Meeting, January 12–16, 2016, in San Antonio, Texas.

Address for reprints: Bellal Joseph, MD, Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, University of Arizona, 1501 N Campbell Ave, Room 5411, PO Box 245063, Tucson, AZ 85724; email:

© 2016 Lippincott Williams & Wilkins, Inc.