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DOI:
https://doi.org/10.57187/5114

Original article

Vol. 156 No. 6 (2026)

Association between frailty and outcomes in emergency department patients requiring emergency general surgery: a retrospective cohort study

Cite this as:
Swiss Med Wkly. 2026;156:5114
Published
26.06.2026

Summary

BACKGROUND: Frailty, a state of increased vulnerability, is a well-established risk factor of adverse outcomes following surgery. While its prognostic value has been demonstrated in various contexts, data are lacking on its impact in emergency general surgery within the Swiss healthcare system. This study aimed to evaluate the association between frailty and outcomes among older patients undergoing emergency general surgery in a Swiss tertiary hospital.

METHODS: We conducted a retrospective cohort study including patients aged 65 years or over who underwent emergency general surgery between January 2016 and December 2019. Eligible procedures included laparotomy, bowel resection, peptic ulcer repair, appendectomy and cholecystectomy performed within 72 hours of admission. Frailty was assessed retrospectively using the Clinical Frailty Scale (CFS), based on clinical documentation. The primary outcome was 1-year mortality. Secondary outcomes included complications, hospital length of stay and discharge destination. Multivariable regression models were used to analyse associations.

RESULTS: Of 683 patients (median age 76 years; 52.7% female), 38.2% were classified as living with frailty (CFS ≥5). One-year mortality was significantly higher among patients with frailty (25.6%) than those without (6.6%), with an adjusted odds ratio (aOR) of 3.0 (95% CI: 1.7–5.1). Frailty was associated with an increased risk of complications (aOR: 2.3; 95% CI: 1.5–3.6), prolonged hospital stay (+46.4%; 95% CI: 26.8–69.0%) and discharge to a location other than home (aOR: 2.1; 95% CI: 1.4–3.2).

CONCLUSION: Frailty is associated with worse outcomes after emergency general surgery in older adults. Routine frailty screening could improve risk stratification and guide patient-centred surgical decision-making.

References

  1. 1. To KB, Kamdar NS, Patil P, Collins SD, Seese E, Krapohl GL, et al.; Michigan Surgical Quality Collaborative (MSQC) Emergency General Surgery Study Group and the MSQC Research Advisory Group. Acute Care Surgery Model and Outcomes in Emergency General Surgery. J Am Coll Surg. 2019 Jan;228(1):21–28.e7. 10.1016/j.jamcollsurg.2018.07.664
  2. 2. Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, et al. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015 Feb;78(2):306–11. 10.1097/TA.0000000000000517
  3. 3. McVeigh TP, Al-Azawi D, O’Donoghue GT, Kerin MJ. Assessing the impact of an ageing population on complication rates and in-patient length of stay. Int J Surg. 2013;11(9):872–5. 10.1016/j.ijsu.2013.07.016
  4. 4. Howes TE, Cook TM, Corrigan LJ, Dalton SJ, Richards SK, Peden CJ. Postoperative morbidity survey, mortality and length of stay following emergency laparotomy. Anaesthesia. 2015 Sep;70(9):1020–7. 10.1111/anae.12991
  5. 5. Cook TM, Day CJ. Hospital mortality after urgent and emergency laparotomy in patients aged 65 yr and over. Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth. 1998 Jun;80(6):776–81. 10.1093/bja/80.6.776
  6. 6. Svenningsen P, Manoharan T, Foss NB, Lauritsen ML, Bay-Nielsen M. Increased mortality in the elderly after emergency abdominal surgery. Dan Med J. 2014 Jul;61(7):A4876.
  7. 7. Fehlmann CA, Taljaard M, McIsaac DI, Suppan L, Andereggen E, Dupuis A, et al. Incidence and outcomes of emergency department patients requiring emergency general surgery: a 5-year retrospective cohort study. Swiss Med Wkly. 2024 Apr;154(4):3729. 10.57187/s.3729
  8. 8. Wilson I, Paul Barrett M, Sinha A, Chan S. Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study. Int J Surg. 2014 Nov;12(11):1157–61. 10.1016/j.ijsu.2014.08.404
  9. 9. Lee KC, Streid J, Sturgeon D, Lipsitz S, Weissman JS, Rosenthal RA, et al. The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study. J Am Geriatr Soc. 2020 May;68(5):1037–43. 10.1111/jgs.16334
  10. 10. Mahmooth Z, Carpenter E, Lin E, Foster M, Haack C, Sharma J, et al. Frailty assessment in the acute care surgery population - the agreement and predictive value on length of stay and re-admission of 3 different instruments in a prospective cohort. Am J Surg. 2020 Oct;220(4):1058–63. 10.1016/j.amjsurg.2020.03.026
  11. 11. Fehlmann CA, Patel D, McCallum J, Perry JJ, Eagles D. Association between mortality and frailty in emergency general surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2022 Feb;48(1):141–51. 10.1007/s00068-020-01578-9
  12. 12. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug;173(5):489–95. 10.1503/cmaj.050051
  13. 13. Pulok MH, Theou O, van der Valk AM, Rockwood K. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing. 2020 Oct;49(6):1071–9. 10.1093/ageing/afaa089
  14. 14. Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P, et al.; ELF Study Group. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br J Surg. 2020 Feb;107(3):218–26. 10.1002/bjs.11392
  15. 15. Vilches-Moraga A, Rowley M, Fox J, Khan H, Paracha A, Price A, et al. Emergency laparotomy in the older patient: factors predictive of 12-month mortality-Salford-POPS-GS. An observational study. Aging Clin Exp Res. 2020 Nov;32(11):2367–73. 10.1007/s40520-020-01578-0
  16. 16. Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, et al.; ELF Study Group. Frailty in Older Patients Undergoing Emergency Laparotomy: Results From the UK Observational Emergency Laparotomy and Frailty (ELF) Study. Ann Surg. 2021 Apr;273(4):709–18. 10.1097/SLA.0000000000003402
  17. 17. Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S, et al. Which frailty scale for patients admitted via Emergency Department? A cohort study. Arch Gerontol Geriatr. 2019;80:104–14. 10.1016/j.archger.2018.11.002
  18. 18. Fehlmann CA, Nickel CH, Cino E, Al-Najjar Z, Langlois N, Eagles D. Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review. Intern Emerg Med. 2022 Nov;17(8):2407–18. 10.1007/s11739-022-03042-5
  19. 19. Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR, et al. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med. 2020 Sep;76(3):291–300. 10.1016/j.annemergmed.2020.03.028
  20. 20. Feeney T, Castillo-Angeles M, Scott JW, Nitzschke SL, Salim A, Haider AH, et al. The independent effect of emergency general surgery on outcomes varies depending on case type: A NSQIP outcomes study. Am J Surg. 2018 Nov;216(5):856–62. 10.1016/j.amjsurg.2018.03.006
  21. 21. Shears M, Takaoka A, Rochwerg B, Bagshaw SM, Johnstone J, Holding A, et al.; Canadian Critical Care Trials Group. Assessing frailty in the intensive care unit: A reliability and validity study. J Crit Care. 2018 Jun;45:197–203. 10.1016/j.jcrc.2018.02.004
  22. 22. Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med. 2014 Sep;64(3):292–8. 10.1016/j.annemergmed.2014.03.025
  23. 23. Haddad T, Mulpuru S, Salter I, Hladkowicz E, Des Autels K, Gagne S, et al. Development and evaluation of an evidence-based, theory-grounded online Clinical Frailty Scale tutorial. Age Ageing. 2022 Feb;51(2):afab258. 10.1093/ageing/afab258
  24. 24. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187–96. 10.1097/SLA.0b013e3181b13ca2
  25. 25. Rutschmann OT, Hugli OW, Marti C, Grosgurin O, Geissbuhler A, Kossovsky M, et al. Reliability of the revised Swiss Emergency Triage Scale: a computer simulation study. Eur J Emerg Med. 2018 Aug;25(4):264–9. 10.1097/MEJ.0000000000000449
  26. 26. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. 10.1016/j.jbi.2008.08.010
  27. 27. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al.; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. 10.1016/j.jbi.2019.103208
  28. 28. Lopez-Ayala P, Riley RD, Collins GS, Zimmermann T. Dealing with continuous variables and modelling non-linear associations in healthcare data: practical guide. BMJ. 2025 Jul;390:e082440. 10.1136/bmj-2024-082440
  29. 29. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007 Mar;165(6):710–8. 10.1093/aje/kwk052
  30. 30. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344–9. 10.1016/j.jclinepi.2007.11.008
  31. 31. McIsaac DI, Moloo H, Bryson GL, van Walraven C. The Association of Frailty With Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study. Anesth Analg. 2017 May;124(5):1653–61. 10.1213/ANE.0000000000001960
  32. 32. Castillo-Angeles M, Cooper Z, Jarman MP, Sturgeon D, Salim A, Havens JM. Association of Frailty With Morbidity and Mortality in Emergency General Surgery By Procedural Risk Level [Internet]. JAMA Surg. 2020;•••: [cited 2025 May 26] 10.1001/jamasurg.2020.5397
  33. 33. Rausei S, Pappalardo V, Ceresoli M, Catena F, Sartelli M, Chiarugi M, et al.; IROA study Group. Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): cohort study. Int J Surg. 2020 Oct;82:240–4. 10.1016/j.ijsu.2020.08.030
  34. 34. Joseph B, Zangbar B, Pandit V, Fain M, Mohler MJ, Kulvatunyou N, et al. Emergency General Surgery in the Elderly: Too Old or Too Frail? J Am Coll Surg. 2016 May;222(5):805–13. 10.1016/j.jamcollsurg.2016.01.063
  35. 35. Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, et al. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg. 2016 Aug;81(2):254–60. 10.1097/TA.0000000000001120
  36. 36. Arteaga AS, Aguilar LT, González JT, Boza AS, Muñoz-Cruzado VD, Ciuró FP, et al. Impact of frailty in surgical emergencies. A comparison of four frailty scales. Eur J Trauma Emerg Surg. 2021 Oct;47(5):1613–9. 10.1007/s00068-020-01314-3
  37. 37. Leiner T, Nemeth D, Hegyi P, Ocskay K, Virag M, Kiss S, et al. Frailty and Emergency Surgery: Results of a Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022 Mar;9:811524. 10.3389/fmed.2022.811524
  38. 38. Ng HJ, Rattray NJ, Quasim T, Moug SJ. Changes in frailty status and discharge destination post emergency laparotomy. World J Emerg Surg. 2025 Apr;20(1):37. 10.1186/s13017-025-00612-8
  39. 39. Tan HL, Chia ST, Nadkarni NV, Ang SY, Seow DC, Wong TH. Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study. World J Emerg Surg. 2019 Dec;14(1):62. 10.1186/s13017-019-0280-z
  40. 40. Søreide K, Desserud KF. Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scand J Trauma Resusc Emerg Med. 2015 Feb;23(1):10. 10.1186/s13049-015-0099-x
  41. 41. Hamel L, Wu B, Brodie M. Views and Experiences with End-of-Life Medical Care in the U.S. [Internet]. https://files.kff.org/attachment/Report-Views-and-Experiences-with-End-of-Life-Medical-Care-in-the-US
  42. 42. Tian BW, Stahel PF, Picetti E, Campanelli G, Di Saverio S, Moore E, et al. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World J Emerg Surg. 2023 Jun;18(1):38. 10.1186/s13017-023-00506-7
  43. 43. Conroy SP, van Oppen JD. Are we measuring what matters to older people? Lancet Healthy Longev. 2023 Jul;4(7):e354–6. 10.1016/S2666-7568(23)00084-3

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