Assessing and managing frailty in emergency laparotomy: a WSES position paper
Brian Tian, Philip F. Stahel, Edoardo Picetti, Giampiero Campanelli, Salomone Di Saverio, Ernest E. Moore, Denis D. Bensard, Boris Sakakushev, Joseph M. Galante, Gustavo Pereira Fraga, Kaoru Koike, Isidoro Di Carlo, Giovanni Domenico Tebala, Ari Leppäniemi, Edward Tan, Dimitrios Damaskos, Nicola de’Angelis, Andreas Hecker, Michele Pisano, YunfengCui, Ron Maier, Belinda De Simone, Francesco Amico, Marco Ceresoli, Manos Pikoulis, Dieter Weber, Walt Biffl, Solomon Gurmu Beka, Fikri M. Abu‐Zidan, Massimo Valentino, Federico Coccolini, Yoram Kluger, Massimo Sartelli, Vanni Agnoletti, Mircea Chirica, Francesca Bravi, Ibrahima Sall, Fausto Catena
Abstract
Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.