Investigation of biology & outcomes of frailty in emergency laparotomy
Research type
Research Study
Full title
An investigation of frailty markers and outcomes in patients requiring emergency laparotomy
IRAS ID
293392
Contact name
Susan Moug
Contact email
Sponsor organisation
NHS Greater Glasgow and Clyde
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Summary of Research
Emergency laparotomy (EmLAP; abdominal surgery) is one of the most common operations performed in the UK (30 000/ year) and is usually on older adults (>65 years). Unfortunately, they carry the highest risk of complications, including death, especially if frail before surgery. Frailty is a reduction in physiological reserve and although prevalent in older adults (20% of EmLAPs), it exists in younger adults too (16% of emergency surgical admissions), a number that is likely to increase post-COVID pandemic. This is compounded by the physiological stress that EmLAP places on these patients that can make frail patients frailer and previously well patients frail. (defined as surgical frailty). Therefore, understanding the mechanisms of frailty is paramount to lead to improvements in outcomes for EmLAP patients.
We will explore the biology of frailty and its influence on patient outcomes on EmLAP patients that are >40 years from a busy district general hospital (>200 EmLaps per year). We will achieve this by 2 planned workstreams.
Workstream 1 will prospectively collect frailty markers before, during and after EmLAP: (a) frailty metabolomics using blood serum/ plasma (b) physical frailty markers: muscle bulk (sarcopenia) on CT (80% of EmLAP patients have at least one CT) and nutrition (Malnutrition Universal Screening Tool; MUST score) (c) Frailty Score/ Questionnaires: Clinical Frailty Score (1 to 9) where 1 is fit and 9 is extremely frail (d) cognitive marker: Abbreviated mental test (AMT). Results from pre-operative, post- operative day 1 and day 7/ discharge day will be compared to post- operative outcomes (day 30 and day 90).
Workstream 2 will focus on defining what matters to EmLAP patients. This will be a mixed-methods approach: systematic review; PPI day; Quality of life (QoL) questionnaires. The questionnaires will be timed with WorkStream 1 to allow changes in QoL to be defined.Summary of Results
Of the 150 recruited patients, 55% were female and 13% died within 90 days after emergency abdominal surgery. 10% of the recruited participants were living with frailty and 11.7% became frail after the emergency abdominal surgery. A panel of metabolites (molecules in blood stream) were found to be present when the participants were frail before the abdominal surgery (p <0.05) and after some statistical analysis, 26 of these metabolites were found to predict death after surgery (p<0.05). The analysis on participant's quality of life showed a poorer result in the frail group but there was a positive improvement at 90 days after the emergency abdominal surgery.
Has the registry been updated to include summary results?: Yes
If yes - please enter the URL to summary results: Ng HJ, Rattray NJW, Quasim T, Moug SJ. Changes in frailty status and discharge destination post emergency laparotomy. World J Emerg Surg. 2025 Apr 25;20(1):37. doi: 10.1186/s13017-025-00612-8REC name
Scotland A: Adults with Incapacity only
REC reference
22/SS/0021
Date of REC Opinion
6 May 2022
REC opinion
Favourable Opinion