Frailty and Short-Term Mortality Following Emergency Laparotomy: Identifying Predictors of Potentially Futile Surgery

Abstract

Frailty is an important determinant of outcomes following emergency laparotomy, especially in the older population more prone to having reduced physiological reserve. This review explores the association between frailty and postoperative mortality and morbidity, compares commonly used frailty assessment tools, and examines its role in perioperative risk prediction and identification of potentially futile surgery. Current evidence consistently demonstrates that frailty is associated with increased 30-day, 90-day and one-year mortality, major postoperative complications, prolonged hospitalisation, functional decline, loss of independence, and discharge to higher levels of care. Frailty can also provide prognostic information beyond chronological age and conventional risk models such as NELA and P-POSSUM, supporting its incorporation into routine perioperative assessment. Importantly, frailty should be used as to inform multidisciplinary decision-making, shared discussions, perioperative planning, and assessment of expected functional recovery. Current evidence supports a shift from mortality-focused risk assessment towards patient-centred evaluation of survival, independence and quality of life. Further research is required to standardise frailty assessment, integrate it with established risk prediction models, and develop validated approaches for identifying patients unlikely to achieve meaningful benefit from emergency laparotomy.