American Journal of Surgery · Aug 21, 2025

Frailty impacts outcomes for all older adult age groups in emergency laparotomy

By Proaño-Zamudio JA, Arda Y, Perkins TM et al.

BACKGROUND: The quantitative effect of frailty on post-operative complications in older adults undergoing surgical emergencies is not well understood. METHODS: The 2013-2019ACS-NSQIP database was used to identify emergency laparotomy patients≥65 years. Frailty was measured using the modified-frailty-index-5 factors (mFI-5). We examined 30-day mortality, discharge to home, post-operative complications and unplanned readmissions. Multivariable logistic regression examined the association between frailty and outcomes. RESULTS: 52,356 patients were included. The median age was 76(70-82) years. Most patients (68 ​%) had an mFI-5 score between 0.2 and 0.5. Higher frailty index was associated with higher mortality and shorter length of survival (log-rank p ​< ​0.001). On multivariable analysis, a higher frailty index was associated with increased mortality, pneumonia, urinary tract infection, respiratory failure, acute kidney injury, and readmission in a linear fashion. CONCLUSION: Increasing levels of frailty not only increase the risk of adverse post-operative outcomes, but also increase the risk of further functional loss and deterioration after discharge.

doi.org/10.1016/j.amjsurg.2025.116571PubMed 40885153Biomarkers