Frailty in surgical patients

Richards, Simon; Frizelle, Frank; Geddes, John A.; Eglinton, Tim; Hampton, Mark B.

doi:10.1007/s00384-018-3163-y

Cited by 90 publications

(81 citation statements)

References 96 publications

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“…Although it is considered more sensitive than the Phenotypic frailty tool [16] , its downsides include the fact that it is time-consuming (up to 70 characteristics assessed sometimes) and its extensive focus on comorbidities (symptoms, diagnoses, abnormal values on laboratory tests, etc.) rather than on functional decline [18] . With the aim to assess frailty in a timely fashion and in a more efficient way, several modified FIs (mFIs), which may measure as few as five factors, have been generated [47] .…”

Section: Frailty Assessment Toolsmentioning

confidence: 99%

“…Numerous frailty screening tools have been described over the years [17,18,41] . The most commonly implemented one is the "Physical Frailty Phenotype" model by Fried et al [14] , which describes frailty as the decrease in physiological reserve secondary to a multisystem functional decline.…”

Section: Frailty Assessment Toolsmentioning

confidence: 99%

“…Frailty syndrome is defined as the increased vulnerability to stressors, loss of ability to adapt, and diminished resiliency secondary to an age-related decline in the physiological reserves and function of multiple organ systems [16,17] . It is essential to distinguish frailty from "comorbidity" and "disability"; although these three terms overlap to some extent and are often used interchangeably to predict patient outcomes, they represent entirely different entities [18] . As described by Feinstein, "comorbidity" is "any distinct additional entity that has existed or may occur during the clinical course of a patient who has the index disease under study" [19] .…”

Section: Introductionmentioning

confidence: 99%

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Frailty and Liver resection: where do we stand?

Sioutas¹,

Ziogas²,

Tsoulfas³

2020

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As the world population is continuously aging, the number of older patients requiring liver surgery is also on the rise. Data have shown that age should not be a limiting factor for liver resection, as it cannot accurately predict postoperative outcomes. Instead, frailty can serve as a more reliable measure of the patient's overall health and functional reserves. Several frailty assessment tools have been implemented for preoperative risk stratification before liver surgery, and higher scores have commonly been associated with postoperative morbidity, mortality, and length of hospital stay. However, no consensus has been reached on the most useful screening tool. Future studies should focus on comparing the currently available assessment tools, constructing a liver resection-specific tool, and assessing the role of frailty assessment tools in preoperative patient optimization.

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Section: Frailty Assessment Toolsmentioning

confidence: 99%

Section: Frailty Assessment Toolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frailty and Liver resection: where do we stand?

Sioutas¹,

Ziogas²,

Tsoulfas³

2020

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“…Although there is no agreed‐upon definition, patients are considered frail if they have three of the following criteria: significant recent unintended weight loss with a low body mass index (BMI), a decreased energy level, a slow walking speed, decreased physical activity, or a weak grip strength . These patients have very high postoperative complication and mortality rates . Many frail patients have sarcopenia (ie, reduced muscle mass).…”

Section: Prehabilitationmentioning

confidence: 99%

Prehabilitation and Optimization of Modifiable Patient Risk Factors: The Importance of Effective Preoperative Evaluation to Improve Surgical Outcomes

Boudreaux¹,

Simmons²

2019

AORN Journal

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“…In particular, gallbladder surgery has been highlighted as accruing excess morbidity and mortality in the elderly patient [9]. The role of frailty as an independent risk factor for adverse postoperative outcomes is also now emerging [10][11][12][13]. An ageadjusted Charlson co-morbidity index [14][15][16] has been recently validated, while limitations in the discriminating power of the prognostic p-POSSUM score have been recognised in the older patient [17].…”

Section: Introductionmentioning

confidence: 99%

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

Bass¹,

Gillis²,

Cao³

et al. 2020

Preprint

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Background: Acute complicated calculous biliary disease (ACCBD) may pose challenges in an ageing population. Frailty and comorbidities increase the potential risks of surgery; thus, surgeons may opt to offer operative treatments less often to their older patients. We set out to capture the incidence and treatment algorithms used across Europe to treat older patients presenting with ACCBD.Methods: Analysis of the European Society of Trauma and Emergency Surgery (ESTES) 2018 Acute Complicated Calculous Biliary Disease audit was performed. Patients undergoing emergency hospital admission with ACCBD between 1 October 2018 and 31 October 2018 were included. The primary outcome measure was operative intervention in patients over and under 65 years of age. Mortalities, post-operative morbidity, time to operative intervention, post-acute disposition and length of hospital stay were measured as secondary outcomes.Results: The median age of the 338 patients admitted to the snapshot was 67 years; 185 patients (54.7%) were over 65 years at time of admission. Significantly fewer patients over 65 underwent definitive surgical treatment, compared with those under 65 (37.8% vs. 64.7%, p <0.001). Surgical complications were seen more frequently in the over 65 cohort. Post-operative mortality was seen in 2.2% of over 65s versus 0.7% under 65(p=0.253). Mean post-operative length of stay was significantly longer in the elderly cohort. In patients surviving to discharge, post-acute convalescence or rehabilitation was required in 13.3% in the elderly cohort versus 1.9% of those under 65 (p=0.002).Conclusions: Elderly patients commonly present with ACCBD. Increased frailty and incidence of comorbid disease in this population increases the potential surgical risk. In our snapshot, elderly patients represented the majority, but far fewer were offered definitive surgical treatment. Post-operative mortality, morbidity, length of post-operative in-hospital stay and the requirement for post-discharge convalescence were higher in this group.

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Frailty in surgical patients

Abstract: Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.

Cited by 90 publications

References 96 publications

Frailty and Liver resection: where do we stand?

Frailty and Liver resection: where do we stand?

Prehabilitation and Optimization of Modifiable Patient Risk Factors: The Importance of Effective Preoperative Evaluation to Improve Surgical Outcomes

Differential Management Strategies and Outcomes in Patients over 65 years with Acute Calculous Biliary Disease—Results and Insights from the ESTES Complicated Biliary Calculous Disease Snapshot Audit

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