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Invited Commentary
November 25, 2020

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

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, Duke University, Durham, North Carolina
  • 2Durham VA Health Care System, Durham, North Carolina
JAMA Surg. 2021;156(1):74-75. doi:10.1001/jamasurg.2020.5398

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.

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