Orthopaedic surgeons’ perceptions of frailty and frailty screening

Abstract

Background: Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. Methods:We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation.Results: Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used. Conclusions: There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.

Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis

“…Stakeholders’ capacity is the crucial factor that affects the successful implementation of frailty screening in primary care. This finding is consistent with the other clinical settings; for example, the lack of knowledge and understanding about frailty and screening was a significant barrier in acute care settings and hospitals [ 56 , 57 ]. Frailty can be positioned as a long-term condition because it shares similar characteristics as other long-term conditions, such as diabetes and arthritis [ 58 ].…”

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures

“…In treatment planning, orthopedic surgeons are likely to consider surgical procedure–specific complications but may be less adept at predicting markers of fragility which are correlated with the likelihood of development of adverse medical complications postoperatively. 3 Rates of medical and surgical complications as well as healthcare resource utilization metrics are all higher in patients with high markers of fragility across multiple surgical fields. 12 , 21 In patients with high frailty status as measured by the Frailty Phenotype and Frailty Index scores, outcomes were significantly worse after elective orthopedic surgical procedures.…”

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of distal humerus fractures

“…In a busy clinic or in the polytrauma situation, the 5-item mFI is more likely to be applied than the 11-item mFI. Given documented poor ability of orthopedic surgeons to predict fragility on a patient-specific basis, 3 a simple, effective tool to do so would be of great value. Moreover, the 5-item mFI when compared with the 11-item mFI appears to be equally efficacious.…”