Frailty, geriatric assessment and prehabilitation in elderly patients undergoing urological surgery – is there a need for change of the daily clinical practice? Synthesis of the available literature

Abstract

Introduction The population of older people is heterogeneous and constantly growing. Over 50% of urological operations are performed in elderly patients. Some elderly patients present with frailty syndrome – a state of increased vulnerability to external stressors resulting in increased risk of hospitalizations, adverse treatment outcomes and death. Currently, there is no widely accepted system of qualification and preparation for surgical treatment developed specifically for elderly patients. Material and methods We searched Medline/Pubmed, Embase and Cochrane Libraries databases from 2000–2020 (week 5). The following medical subject headings (MeSH) terms were used to ensure the sensitivity of the searches: geriatric assessment, frailty, urology, and prehabilitation. Relevant articles were also identified through a manual search of the reference lists of potentially relevant articles. Results A total of 23 papers met the criteria and were included in the current study. Screening for frailty seems to be promising in predicting adverse outcomes, but frail patients should undergo detailed geriatric assessment (GA) which may indicate a need for preoperative intervention which can be unavailable during the hospitalization. The concept of prehabilitation is becoming increasingly discussed in thoracic and abdominal surgery, but only a few studies are available in the field of urology. Conclusions Geriatric assessment seems to be a valuable tool for urologists in daily clinical practice. A proper form of prehabilitation may provide enhanced recovery after surgery.

Utility of the Age Discrepancy between Frailty-Based Biological Age and Expected Life Age in Patients with Urological Cancers

“…Frailty assessment in elderly patients with cancers is important in managing the balance between harms and benefits [ 23 , 24 , 25 , 26 , 27 , 28 ]. However, a full geriatric assessment in all candidates is time-consuming and is not feasible in clinical practice [ 10 , 29 , 30 ]. Importantly, the main problem of frailty assessment is the non-intuitiveness of each frailty score, as several frailty assessment tools have identified different frail criteria (a nonfrail, prefrail, or frail) [ 21 , 31 ].…”

Predictors of prolonged admission after outpatient female pelvic reconstructive surgery

“…Prehabilitation, or preoperative intervention aimed at preparing the patient for the physiologic stress of surgery, was initially applied in the context of thoracic and abdominal surgery and is increasingly being studied for application in urologic surgery. 27 Prehabilitation before radical cystectomy has resulted in faster functional recovery. 28 Additionally, implementation of enhanced recovery after surgery (ERAS) protocols and prehabilitation has decreased prolonged LOS for patients undergoing robot-assisted radical prostatectomy.…”