Associations of Preoperative Frailty With Cancer and Noncancer Deaths of Older Adults Following Surgery for Cancer—Reply

Abstract

to use in conjunction with, or in lieu of, minimum case volume requirements. This would allow for better determination of which residents are prepared to graduate under the American Board of Surgery's modified training requirements during the pandemic.The variability in resident operative experience is another problem. Even prior to the pandemic, general surgery residency graduates in the United States reported significant variability in operative experiences between individuals. 4 The COVID-19 pandemic likely increased this variability, as residents who rotated on specific specialty services during COVID-19 surges may not be able to recoup these significant gaps in their training. This does not only apply to operative experiences, but also to clinical experiences, where they learn to evaluate and manage patients both preoperatively and postoperatively. This may have a downstream effect, such as on future fellowship decisions, as already limited exposure to certain elective subspecialties may have been lost during the COVID-19 pandemic.In conclusion, we agree that there is more to procedural competence than operative volume. In fact, we feel that the COVID-19 pandemic adds a sense of urgency to transitioning to a competency-based assessment of surgical trainees. In the meantime, programs should consider trying to identify whether individual residents have areas of clinical deficiencies as a result of the pandemic to create opportunities to make up for lost experience.

Association Between Frailty and Time Alive and At Home After Cancer Surgery Among Older Adults: A Population-Based Analysis

“…Understanding these repercussions is crucial in delivering patient-centered care, because older adults place higher importance on long-term functional independence and quality of life than on short-term risk. [6][7][8][9][10][11] The ability to maintain independence is essential for older adults. However, there are few data on functional outcomes after cancer surgery, with most studies limited to 6-to 12-month time horizons.…”