If the Patient Is Frail, Emergency Abdominal Surgery Is High Risk

When a patient with frailty undergoes a high-risk emergency procedure, an increased incidence of adverse events is expected. Castillo-Angeles and colleagues’ study¹ in this issue of JAMA Surgery validates this belief but also demonstrates that frailty is associated with worse outcomes even after low-risk procedures. In their analysis of more than 880 000 emergency general surgery procedures captured in the Medicare Inpatient Claims files (from 2007 through 2015), the authors¹ found that patients with frailty were twice as likely to die within 30 days of discharge following low-risk emergency surgery (appendectomy or cholecystectomy). This risk was much higher than a 53% increase in odds of mortality after high-risk emergency surgery (exploratory laparotomy, lysis of adhesions, bowel resection, or peptic ulcer repair). Consistent with results of another recent study,² which examined the association of frailty with outcomes following laparoscopic cholecystectomy for acute cholecystitis, these findings indicate that there is no such thing as a low-risk intra-abdominal operation for a patient with frailty.