Frailty in the perioperative setting

Dhesi, Jugdeep; Lees, Nicholas P.; Partridge, Judith

doi:10.7861/clinmed.2019-0283

Cited by 32 publications

(28 citation statements)

References 34 publications

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“…A potential modification of the syndrome well in advance of potential surgery may also be included in the benefits of frailty assessment: pharmacological interventions, nutritional supplementation, prehabilitation exercise programmes, etc. [ 43 ]. These subjects have not been addressed in this study.…”

Section: Discussionmentioning

confidence: 99%

Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer

et al. 2021

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Background Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyze the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients. Methods A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumor extent, and post-operative outcomes, which were mortality at 30 days, 90 days, and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival. Results Out of the 149 patients, 96 (64.4%) were men and 53 (35.6%) were women, with a median age of 75 years (IQR 72–80). According to the CSHA-CFS scale, 59 (39.6%) patients were frail, and 90 (60.4%) patients were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p = 0.001); the Lawton-Brody Index (p = 0.011); failure to perform an anastomosis (p = 0.024); nodal involvement (p = 0.005); distant metastases (p < 0.001); high TNM stage (p = 0.004); and anastomosis dehiscence (p = 0.013) were significant univariate predictors of a poor prognosis on univariate analysis. Multivariate analysis of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p = 0.002; HR 1.30; 95% CI 1.10–1.54) and TNM stage (p = 0.014; HR 2.06; 95% CI 1.16–3.67) were the only independent risk factors for survival at 5 years. Conclusions Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in older patients with colorectal cancer. Instead, comorbidities and tumor stage are good predictors of long-term survival.

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Section: Discussionmentioning

confidence: 99%

Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer

et al. 2021

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“…Nutrition, obesity and muscle weakness have also been used to assess frailty in older patients because these can cause infection, loss of physical function, and an elevated mortality rate (48). A reduction in physical function and activity, appetite and energy consumption may lead to the progression of malnutrition (17,40,51). Calculation of BMI has been widely used in risk stratification with conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Tóth¹,

Szabó²,

Nagy³

et al. 2021

Ann Palliat Med

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Background: The frailty score has been developed to determine physiological functioning capacity. The aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery patients.Methods: Our research is an observational, single-center, prospective cohort study (registered on ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze survival and relative risk. The primary outcome was mid-term mortality.Results: The patients' mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median followup was 1,656 days of survival [interquartile range (IQR), 1,336-2,081 years], during this period 14 patients died. The median of EuroSCORE II was 1.56 (1.00-2.58) points. The median preoperative albumin level was 32.80 g/L (IQR, 29.9-35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred 7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10-25.91, P=0.037]. After adjustment for EuroSCORE II and postoperative complications the noncardiovascular CGA score was associated with overall mortality [adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02-2.04, P=0.036]. In the multivariable Cox regression, GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52-14.92, P=0.007). Conclusions:The CGA-based noncardiovascular score and nutritional status should be assessed before cardiac surgery prehabilitation and may help decrease long-term mortality.

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“…The patient then undergoes further optimisation with pre-operative protocols to normalise haemoglobin levels, managing medications for comorbidities, and consideration of coincidental immunologics [ 11 ]. We assess frailty (Clinical Frailty Scale) and use strategies to improve strength and endurance [ 23 ]. Cognitive testing is part of perioperative assessment.…”

Section: Our York Pathwaymentioning

confidence: 99%

A structured pathway for developing your complex abdominal hernia service: our York pathway

Smith

MacLeod

Lim

et al. 2021

Hernia

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Purpose Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors’ knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. Methods A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. Results We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. Conclusion A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.

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Frailty in the perioperative setting

Cited by 32 publications

References 34 publications

Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer

Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

A structured pathway for developing your complex abdominal hernia service: our York pathway

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