The prevalence of frailty in older patients undergoing emergency surgery at the University Hospital of the West Indies

Introduction

Jamaica, like many countries worldwide, has experienced a steadily ageing population for several decades. Frailty is defined as an age-related increase in vulnerability to stressors such as acute illness and surgery, and its presence and severity are powerful predictors of adverse surgical outcomes. The prevalence of frailty varies widely and is believed to be high in low- and middle-income countries (LMICs). Recent local data suggest that frailty affects as many as 40% of older elective surgical patients. Given its strong association with perioperative complications and Jamaica’s ageing surgical population, understanding the prevalence and clinical significance of frailty in older surgical patients is important for resource allocation and perioperative planning. The main objective of this study was to determine the prevalence of frailty in patients aged 60 years and older undergoing emergency surgery at the University Hospital of the West Indies (UHWI).

Methods

This was a single-centre retrospective cross-sectional study. Emergency cases were identified from post-operative care unit logbooks, and demographic and clinical data were extracted from electronic and paper records. Frailty status was assessed using the modified Frailty Index-11. Secondary objectives were to determine demographic features associated with frailty and to assess its associations with mortality, length of hospital stay, and perioperative complications.

Results

Data were extracted for 174 patients. The prevalence of frailty was 67%. Frail patients were significantly older and had a greater burden of comorbidities. Frailty was independently associated with increased 30-day mortality (OR 4.07, 95% CI: 1.27–15.9, p = 0.027), after adjustment for age and comorbidities. Although not statistically significant, frailty was also associated with an increase in hospital length of stay and postoperative complications.

Conclusion

Frailty was highly prevalent in older emergency surgical patients at UHWI and was associated with increased morbidity and mortality. Routine frailty screening and multidisciplinary perioperative optimisation strategies may help improve outcomes in this vulnerable population.