Scoping review of frailty in vascular surgery

Long-Term Impact of Vascular Surgery Stress on Frail Older Patients

“…Given how varying stress levels can significantly impact postoperative outcomes among frail patients, an argument can be made that surgical stress levels need to be estimated before surgery and calculated after surgery for these high-risk patients. Estimating the degree of stress that a frail patient will likely encounter during vascular surgery will help inform risk prediction and clinical decision making, 17 whereas calculating the amount of stress a frail patient actually experienced during the perioperative period can help surgical providers determine what level of supportive care these patients will likely need in the postacute care setting. These are important data for caregivers and families to have so that there are reasonable expectations for long-term recovery and to acknowledge uncertainly regarding their return to baseline functional independence in a home setting.…”

Frailty leads to poor long-term survival in patients undergoing elective vascular surgery

“…Individualized multicomponent therapies could be created to treat frailty, and existing frailty should be reduced to improve postoperative outcomes and, hopefully, survival. 1 The Comprehensive Geriatric Assessment is a diagnostic and therapeutic process that determines the physiologic and functional capability of a frail patient to create an individualized treatment plan. 42,43 It has been shown that performing a Comprehensive Geriatric Assessment increases survival and decreases the length of hospital stay.…”

“…Studies have demonstrated that neither chronologic age nor multimorbidity, most often defined as "the coexistence of at least three chronic conditions over a span of at least one year," can be used to distinguish between a fit and frail patient. 1,2 Frailty is a complex state of a decreased physiologic reserve, resulting in increased susceptibility to stressors that is separate from the natural process of aging. Thus, it is considered a geriatric syndrome composed of several domains (ie, physical, cognitive, and psychosocial) describing the weakest adults.…”

Moving frailty assessment beyond knowing it when you see it

“…The heterogeneous methods used by the papers they analyzed also highlight the immaturity of this line of researchdsomething that needs to be overcome. A recent review by Drudi et al 9 in the Journal of Vascular Surgery makes the same point. Frailty assessment should become as routine (and easy) as taking vital signs.…”