The Importance of Incorporating Frailty Screening Into Surgical Clinical Workflow

George, Elizabeth; Arya, Shipra

doi:10.1001/jamanetworkopen.2019.3538

Cited by 14 publications

(12 citation statements)

References 9 publications

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“…Although the majority of participants emphasized the merits of frailty screening in primary care, some participants recognised that a formal frailty screening score could alert to possible issues postoperatively, allow for targeted optimization of risks pre-surgically, and provide a benchmark for future assessment and follow up in orthopaedic practice contexts. This insight is suggestive of a strong potential clinical impact-even rapid frailty assessment tools have demonstrated excellent negative predictive values in surgical contexts [46]. This knowledge could be translated to change orthopaedic surgeon's perceptions of their professional role in identifying frailty, and could help optimise orthopaedic management plans through integration of assessment and interventions by other disciplines, thereby leveraging the pragmatic application of frailty screening data for clinical benefit.…”

Section: Discussionmentioning

confidence: 93%

Orthopaedic surgeons’ perceptions of frailty and frailty screening

2020

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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.

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Section: Discussionmentioning

confidence: 93%

Orthopaedic surgeons’ perceptions of frailty and frailty screening

2020

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“…Although the majority of participants emphasized the merits of frailty screening in primary care, some participants recognised that a formal frailty screening score could alert to possible issues postoperatively, allow for targeted optimization of risks pre-surgically, and provide a benchmark for future assessment and follow up in orthopaedic practice contexts. This insight is suggestive of a strong potential clinical impact-even rapid frailty assessment tools have demonstrated excellent negative predictive values in surgical contexts [42]. This knowledge could be translated to change orthopaedic surgeon's perceptions of their professional role in identifying frailty, and could help optimise orthopaedic management plans through integration of assessment and interventions by other disciplines, thereby leveraging the pragmatic application of frailty screening data for clinical benefit.…”

Section: Discussionmentioning

confidence: 93%

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

Archibald

Lawless

Gill

et al. 2019

Preprint

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“…Several recent editorials describe a role for rapid frailty assessment tools with high negative predictive values to rule out frailty in surgical candidates, while allowing for patients who screen positive for frailty to undergo more rigorous preoperative assessments. 31,68 These assessments may include a CGA, an interdisciplinary approach that systematically evaluates physical, functional, cognitive, environmental, and social domains for an older adult. 69 An individualized treatment plan resulting from concerted interdisciplinary effort is the goal of a successful CGA.…”

Section: Discussionmentioning

confidence: 99%

“…Active measurement of cognitive function is important as these measures may be used to determine a patient's response to perioperative stressors and could allow monitoring of longitudinal cognitive trajectory. 31 With respect to the feasibility of incorporating cognitive assessment into an outpatient preoperative visit, the Montreal Cognitive Assessment (MoCA)-a well-validated study with high reliability-can be completed in approximately 10 minutes. 29 A review by Long et al 32 details several other short (≤2.5 minutes) cognitive assessments that can be completed preoperatively including the Mini-Cog, which consists of a 3-word recall and clock drawing test.…”

Section: Cognitive Assessmentsmentioning

confidence: 99%

Preoperative Evaluation of the Frail Patient

Nidadavolu¹,

Ehrlich²,

Sieber³

et al. 2020

Anesthesia &Amp; Analgesia

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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.

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The Importance of Incorporating Frailty Screening Into Surgical Clinical Workflow

Cited by 14 publications

References 9 publications

Orthopaedic surgeons’ perceptions of frailty and frailty screening

Orthopaedic surgeons’ perceptions of frailty and frailty screening

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

Preoperative Evaluation of the Frail Patient

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