ThTP5.2 Outcome of polypharmacy in frail patients post emergency laparotomy

Abstract

Abstract Aims The causal effect relationship between frailty and polypharmacy is not clearly established. Medications are used to treat co- morbidities that cause frailty but the side effects of the drugs could also be the stressors leading to frailty. Moreover, high risk of mortality is associated with frail emergency laparotomy patients. We aim to explore the association between 30- day mortality and frailty with polypharmacy. Methods A prospective database of emergency laparotomy (EmLap) patients in a busy district hospital was analysed. Patients ≥40 years old who underwent EmLap as per NELA criteria were included. Frailty was assessed via Clinical Frailty Score with score ≥4 as frail. Polypharmacy was defined as ≥5 daily medications. Statistical analysis was performed using logistic regression and p value of <0.05 was considered significant. Results 100 patients were included with 41% male and median age of 66 years. The overall 30- day mortality rate was 9%. Frailty was present in 49% and mortality rate was 16.3% (OR 79.76, p= 0.0121). Polypharmacy was found in 36% and mortality rate was 16.7% (OR 4.07, p= 0.045). There was significant association between frailty and polypharmacy (p=0.012). When both frailty and polypharmacy were present (25%), the mortality rate was 20% (OR 5.55, p= 0.026). Conclusion Frailty increases risk of polypharmacy and polypharmacy poses risk of worsening frailty, Mortality rate post EmLap is higher when EmLap patients are both frail and have polypharmacy. It is important to rationalise and review patient’s drug therapy in the community as well as in hospital.