Frailty and anesthesia – risks during and post-surgery

Abstract

Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

“…The prevalence of frailty is estimated to be at 10–15% among those between 65 to 75 years old. This frequency increases to more than 40% among those beyond 85 years old 3 , 5 – 7 . However, despite several frailty assessment tools being available, routine assessment is not commonly done prior to elective surgery 8 – 10 .…”

“…Frailty is defined as the biologic syndrome of a decreased physiological reserve, resulting from the cumulative declines of multiple organ systems, which predisposes one to adverse outcomes when exposed to stressors such as surgery 1 , 2 . As frailty is the composite effect of multiple organ deficiencies, it has been shown to be better in predicting hospitalization stay, complications and morbidity among the elderly patients when compared to individual assessment of medical comorbidity or functional status 1 , 3 .…”

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

“…1,2 As frailty is the composite effect of multiple organ deficiencies, it has been shown to be better in predicting hospitalization stay, complications and morbidity among the elderly patients when compared to individual assessment of medical comorbidity or functional status. 1,3 There is an increasing number of non-cardiac surgeries done among elderly people worldwide. 4 The prevalence of frailty is estimated to be at 10-15% among those between 65 to 75 years old.…”

“…This frequency increases to more than 40% among those beyond 85 years old. 3,[5][6][7] However, despite several frailty assessment tools being available, routine assessment is not commonly done prior to elective surgery. [8][9][10] Furthermore, a patient's preoperative optimization strategy rarely incorporates the formal diagnosis of frailty.…”

Assessing effect of anaesthetic methods on postoperative cognitive dysfunction

“…2 Moreover, as frail elderly patients are more likely to have pre-existing cognitive impairment with reduced cognitive reserve, they are most vulnerable to POCD. 3 Second, the mean bispectral index was significantly lower in the sevoflurane group than in the propofol group, but details of intraoperative management were not provided. Thus, it is difficult to determine the extent of influence that anaesthetists' interventions might have on the occurrence of POCD.…”