Preoperative Evaluation of the Frail Patient

Abstract

Perioperative management of older adults is a complex field that is heavily influenced by the clinical heterogeneity of older adults. Frailty-a geriatric syndrome in which a patient is more vulnerable to stressors due to decreases in physical function and reserve-has been indicative of adverse postoperative outcomes. Many tools have been developed to measure frailty that incorporate a variety of factors including physical and cognitive function, comorbidities, selfreported measures of health, and clinical judgment. Most of these frailty assessment tools are able to identify a subset of patients at risk of adverse outcomes including postoperative complications, longer hospital length of stay, discharge to a higher level of care, and mortality. Frailty assessment before surgical interventions can also guide discussions among patients, their families, anesthesiologists, and surgeons to tailor operative plans for patients to mitigate this increased risk. Studies are ongoing to identify interventions in frail patients that can improve postoperative outcomes, but high-quality data in the form of randomized controlled trials are lacking at this time. In the United States, approximately one-third of all operating room-based procedures are performed on adults ≥65 years.

Frailty-aware care: giving value to frailty assessment across different healthcare settings

“…Frailty is recommended as an assessment of patient resiliency in the preoperative period [ 73 , 98 ]. Increasing complexity of surgical patients with comorbidities and functional limitations has meant that frailty assessment increasingly provides additional utility to current methods of risk stratification preoperatively [ 120 ].…”

“…Due to flexibility and thorough validation, the FI approach has been suggested for use in the preoperative setting [ 121 , 122 ]. Simplified FIs with less variables and easily collected data have been recommended [ 98 , 101 ]. For example, a modified FI (mFI) has been created using a simplified FI designed with only 11 variables and has been tested in surgical settings [ 123 , 124 ].…”

“…Despite the promising research advocating for frailty assessment in perioperative practice, frailty assessment has yet to become widely adopted. Frailty assessment should be strongly considered for standard preoperative care to identify those who are less likely to receive benefit from invasive procedures and to identify those who should receive prehabilitation prior to surgical intervention [ 98 , 127 ]. Considerations for frailty assessment in the preoperative setting are summarized in Fig.…”

“…Further work is needed to identify optimal approaches for acting on this information in those identified as being frail either through personalized care management, the identification of goals of care or interventional approaches. Clinical settings identify not only the need for intervention addressing frailty status, but also for frailty-informed care management [ 69 , 73 , 81 , 98 ].…”

Implementation of a machine learning application in preoperative risk assessment for hip repair surgery

“…A comprehensive preoperative evaluation can enhance the quality of patient care and is associated with a reduced mortality rate [ 1 – 3 ]. In preoperative evaluation clinics, the anesthesiologist must evaluate the patient's medical history and laboratory data, determine the patient’s physical status, and draw up a preoperative management plan in a limited time.…”