The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score fo
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ORIGINAL ARTICLE
The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery Gianluca Costa1 · Laura Bersigotti1,5 · Giulia Massa1 · Luca Lepre2 · Pietro Fransvea3 · Alessio Lucarini1 · Paolo Mercantini1 · Genoveffa Balducci1 · Gabriele Sganga3 · Antonio Crucitti4 on behalf of ERASO (Elderly Risk Assessment, Surgical Outcome) Collaborative Study Group Received: 29 May 2020 / Accepted: 3 October 2020 © The Author(s) 2020
Abstract Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk. Keywords Frailty · Emergency surgery · Predictive tool · Procedure-specific morbidity
Introduction The abstract of this paper was presented at the ACS (American College of Surgeons) Clinical Congress 2019, San Francisco, CA, October 2019 (ClinicalTrials.gov identifier: NCT02825082). The list of authors in ERASO Collaborative Study Group is processed in acknowledgements section. * Laura Bersigotti [email protected]; [email protected] 1
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Department of Medical‑Surgical Science and Translational Medicine, Sant’Andrea Teaching Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035, Rome, Italy General Surgery Unit, Santo Spirito
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