Failure to Rescue After Emergency General Surgery in Geriatric Patients: Does Frailty Matter?

Abstract Background Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients. Methods We performed a 3-y (2015-2017) prospective cohort study of all geriatric patients (age ≥ 65 y) requiring EGS. Frailty was calculated by using the EGS-specific Frailty Index (EGSFI) within 24 h of admission. Patients were divided into two groups: frail (FI ≥ 0.325) and nonfrail (FI  Results Three hundred twenty-six geriatric EGS patients were included, of which 38.9% were frail. Frail patients were more likely to be white ( P P  = 0.03) and lower serum albumin ( P P  = 0.54), gender ( P  = 0.56), admission vitals, and WBC count ( P  = 0.35). Overall, 26.7% ( n  = 85) of patients developed in-hospital complications; and mortality occurred in 30% ( n  = 26) of those patients (i.e., the FTR group). Frail patients had higher rates of FTR (14% vs. 4%, P Conclusions Our study demonstrates that in geriatric EGS patients, a frail status independently contributes to FTR and increases the odds of FTR threefold compared with nonfrail status. Thus, it should be included in quality metrics for geriatric EGS patients.