Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

Archibald, Mandy M.; Lawless, Michael; Gill, Tiffany K.; Chehade, Mellick

doi:10.21203/rs.2.12117/v1

Cited by 7 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, while frailty screening was carried out in primary settings to avert the frail status of patients, this may not be practical or applicable in the acute settings. Another study with surgeons showed that frailty screening could lead to less adverse outcomes in the peri-operative period [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

Liu

Lim

et al. 2022

BMC Geriatr

View full text Add to dashboard Cite

Background COVID-19 pandemic has reminded how older adults with frailty are particularly exposed to adverse outcomes. In the acute care setting, consideration of evidence-based practice related to frailty screening and management is needed to improve the care provided to aging populations. It is important to assess for frailty in acute care so as to establish treatment priorities and goals for the individual. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, and identify barriers and facilitators concerning frailty screening and its implementation. Methods A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anesthesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through purposive sampling of specific clinicians seeing a high proportion of older patients at the hospitals. Thematic analysis of the data was performed using NVIVO 12.0. Results Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered important to identify high risk patients, to implement targeted treatment and care, and to support decision making and prognosis estimation. Specific issues related to screening, management and implementation were identified: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties. Conclusion Our findings indicated the need for 1) frailty-related education program for patients/care givers and stakeholders 2) inter-professional collaboration to develop integrated approach for screening and management of hospital patients with frailty and 3) hospital-wide consensus to adopt a common frailty screening tool.

show abstract

Section: Discussionmentioning

confidence: 99%

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

Liu

Lim

et al. 2022

BMC Geriatr

View full text Add to dashboard Cite

show abstract

“…These patients have a decreased physiologic reserve and may have a more significant inflammatory response to trauma, even with relatively small injuries. 28,29 CCI and ASA classification are both used to stratify patient risk prior to surgery. Our study showed that increased CCI is associated with an in increased risk for discharge to a facility and ASA class IV or V also increased the risk of post-operative complications.…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes After Surgical Management of Geriatric Patella Fractures

Kapilow

Ahn

Gallaway

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

show abstract

“…40 Most surgeons understand that geriatric syndromes such as frailty impact postoperative outcomes but report that they are unsure about the value of routine screening, are reluctant to record frailty in a patient's medical record and acknowledge that its management is outside their scope of practice. 41 In addition to frailty, cognitive impairment also poses challenges for surgeons. Under-recognition of cognitive impairment could have implications for validity of informed consent and might limit a person's capacity to understand treatment options 42 and participate in shared decision-making.…”

Section: Evidence For Collaborative Perioperative Care Of Older Peoplementioning

confidence: 99%

“…The complexity of patients presenting for surgery now exceeds the capacity of any one craft group to manage independently and patients benefit from a team‐based approach to care 40 . Most surgeons understand that geriatric syndromes such as frailty impact postoperative outcomes but report that they are unsure about the value of routine screening, are reluctant to record frailty in a patient's medical record and acknowledge that its management is outside their scope of practice 41 . In addition to frailty, cognitive impairment also poses challenges for surgeons.…”

Section: The Benefits For Surgeons From Collaborative Care Of Older Pmentioning

confidence: 99%

Sharing the helm: medical co‐management for the older surgical patient

Fleury

McGowan

Burstow

et al. 2020

ANZ Journal of Surgery

View full text Add to dashboard Cite

Sharing the helm: medical co-management for the older surgical patient The management of frail older patients with multiple comorbidities requires considerable medical expertise. While all surgeons are doctors, the rapid expansion of evidence relating to best treatment means that no medical practitioner can expect to be expert in all aspects of patient care. Greater scrutiny of surgical outcomes through initiatives such as the Australian and New Zealand Audit of Surgical Mortality 1 and the Australian and New Zealand Emergency Laparotomy Quality Improvement quality initiative 2 has reframed the concept of quality surgical care from the outcome of the procedure alone to encompass the whole patient journey and highlighted the importance of older age, frailty and comorbidity in determining outcomes. Multidisciplinary consultation and decisionmaking around optimal management depends upon collaboration between different specialties. The Royal Australasian College of Surgeons competency framework recognizes the importance of non-technical skills required of today's surgeon in providing patient-centred care. 3,4 This article discusses medical expertise and collaboration as applied to the management of older surgical patients and provides a practical example of a service, which strives to meet this challenge, but the authors recognize there is considerable overlap with the other competencies, particularly 'communication', 'management and leadership', 'decision-making' and 'professionalism'.

show abstract

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

Abstract: Background

Cited by 7 publications

References 35 publications

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

Early Outcomes After Surgical Management of Geriatric Patella Fractures

Sharing the helm: medical co‐management for the older surgical patient

Contact Info

Product

Resources

About