Frailty And The Perioperative Period

Abstract

In most countries the population is aging and the amount of surgery being performed on elderly patients is increasing.

Methods used to stratify perioperative risk in elderly patients are limited because they do not assess the physiological reserve of a patient.

Frailty is a term that is widely used but as yet has no standardised definition. It can be described as a common geriatric syndrome that identifies patients with reduced physiological reserves in multiple organ systems, which results in increased vulnerability to physiological stressors.

Features common to most definitions of frailty include reduced muscle strength, unintentional weight loss, tiredness or fatigue, low physical activity and slow walking.

Scientific literature shows an association between frailty and thirty day post-operative complications, length of stay in hospital, and discharge to a skilled or assisted living facility.

Risk factors for frailty can be classified into physiological, psychological or sociodemographic risk factors, disability and comorbidities. Some of these risk factors are modifiable.

Assessing frailty using a validated, objective scoring system can be performed efficiently in the pre-admission clinic setting.

Assessment of elderly patients presenting for emergency surgery can be more difficult. However, a reasonable attempt can be made by keeping the core features of frailty in mind during the patient assessment.