Editorials and commentaries
30 December 2024
Vol. 1 No. 1 (2025)
https://doi.org/10.4081/sigaf.2025.10

Frailty in emergency general surgery and the role of the perioperative physician/geriatrician

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Surgery, elderly patients, frailty
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Authors

Dimitrios Damaskos
dimitris.damaskos@gmail.com
Department of General Surgery, Royal Infirmary of Edinburgh, UK; Department of General Surgery, University of Edinburgh, United Kingdom.
Carlo Vallicelli
Department of General Emergency and Trauma Surgery, Maurizio Bufalini Hospital, Cesena, Italy.

The aging of the population is a fact, and with it, our surgical patients are becoming increasingly more complex and frailer. It is a well-known aspect of our practice nowadays, but its impact was not recognized until recently. The article by Pearse et al.1 showed us that mortality in major abdominal/colonic procedures in patients over 69 years of age is significant, perhaps more than we wanted to believe. The issues around the need for better care for elderly patients undergoing emergency surgery were subsequently identified in the Peri-operative Care: Knowing the Risk NCEPOD document (2011).2 In that report, the role of frailty has been highlighted by the authors and particular attention was given to multiple comorbidities/polypharmacy/cognitive and sensory impairment compromising the outcomes of these patients. The subsequent (2015) National Emergency Laparotomy Audit report3 issued specific recommendations that patients over 70 undergoing an emergency laparotomy should have Input from specialist Care of the Elderly teams. [...]

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Pearse RM, Harrison DA, James P, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 2006;10:R81. DOI: https://doi.org/10.1186/cc4928
National Confidential Enquiry into Patients Outcome and Death (NCEPOD). Peri-operative Care: Knowing the Risk. 2011. Available from: https://www.ncepod.org.uk/2011poc.html
National Emergency Laparotomy Audit. First Report of the National Emergency Laparotomy Audit. 2015. Available from: www.nela.org.uk
Royal College of Surgeon. The High-Risk General Surgical Patient: Raising the Standard. 2018. Available from: https://www.rcseng.ac.uk/-/media/Files/RCS/News-and-events/Media-centre/2018-press-releases-documents/RCS-Report-The-HighRisk-General-Surgical-Patient--Raising-the-Standard--December-2018.pdf
Shipway D, Partridge J, Braude P, Vilches-Moraga A. British Geriatrics Society position statement: older patients undergoing emergency laparotomy. Age Ageing, 2021;50:268–269. DOI: https://doi.org/10.1093/ageing/afaa172
Tian BWCA, Stahel PF, Picetti E, et al. Assessing and managing frailty in emergency laparotomy: a WSES position paper. World J Emerg Surg 2023;18:38. DOI: https://doi.org/10.1186/s13017-023-00506-7
Peden CJ, Aggarwal G, Aitken RJ, et al. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization. World J Surg 2021;45:1272-1290. DOI: https://doi.org/10.1007/s00268-021-06083-7
Viswanath M, Clinch D, Ceresoli M, et al. Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey. World J Emerg Surg 2023;18:7. DOI: https://doi.org/10.1186/s13017-022-00471-7

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Frailty in emergency general surgery and the role of the perioperative physician/geriatrician. (2024). Surgery in Geriatrics and Frailty, 1(1). https://doi.org/10.4081/sigaf.2025.10
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