title: The impact of frailty syndrome and risk scores on emergency cholecystectomy patients.
abstract: OBJECTIVE
  Cholecystectomy, which is one of the most common surgical procedures, is also performed in the emergency setting. A number of risk scores have been introduced in recent studies; moreover, over the last few years literature has focused on surgical patients with frailty syndrome. The aim of the present study is to evaluate whether frailty syndrome and the risk scores are correlated with morbidity, post-operative hospital stay and the ICU admission rate following emergency cholecystectomy.
  
  
  METHODS
  Eighty-five consecutive patients of >65 years of age who underwent cholecystectomy were selected from 2306 emergency procedures for inclusion in the present study. The patients were assessed for frailty syndrome and their scores were calculated on the basis of chart review. Univariate analyses were performed to compare severe frailty patients to intermediate frailty and robust patients. ROC and logistic regression analyses were performed with the end-points of morbidity, hospital stay and ICU admission.
  
  
  RESULTS
  In addition to having worse ASA, inflammatory and risk values than robust patients, frailty syndrome patients also had higher rates of morbidity and ICU admission and longer hospitalization periods. A logistic regression analysis showed that the P-Possum was independently correlated with morbidity. Frailty and open surgery were independently correlated with longer hospitalization, whereas ICU admission was correlated with worse ASA and P-Possum values.
  
  
  CONCLUSIONS
  Frailty syndrome significantly impacts the length of hospitalization in patients undergoing emergency cholecystectomy. Although the ORs were limited, the P-Possum value was independently associated with the outcome.
authors.affiliation: Surgical and Medical Department of Traslational Medicine, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189, Rome, Italy. laura.lorenzon@uniroma1.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Lorenzon
authors.affiliation: Surgical and Medical Department of Traslational Medicine, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Costa
authors.affiliation: Surgical and Medical Department of Traslational Medicine, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Massa
authors.affiliation: Surgical and Medical Department of Traslational Medicine, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Frezza
authors.affiliation: Health Department, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Stella
authors.affiliation: Surgical and Medical Department of Traslational Medicine, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-39, 00189, Rome, Italy.
authors.forename: Genoveffa
authors.initials: G
authors.lastname: Balducci
mesh_terms: D000367:Age Factors; D000368:Aged; D002763:Cholecystectomy / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D000073496:Frailty / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D010343:Patient Admission / Q000706:statistics & numerical data; D011379:Prognosis; D012372:ROC Curve; D012306:Risk
keywords: Charlson age-comorbidity index; Cholecystectomy; Frailty; P-Possum; SAPS-II