Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI)

Álvarez-Nebreda, M.L.; Bentov, Nathalie; Urman, Richard D.; Setia, Sabeena; Huang, Joe C.; Pfeifer, Kurt; Bennett, Katherine A.; Ong, Thuan D.; Richman, Deborah C.; Gollapudi, Divya; Rooke, G. Alec; Javedan, Houman

doi:10.1016/j.jclinane.2018.02.011

Cited by 150 publications

(124 citation statements)

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“…Options may include the FRAIL scale, Edmonton Frail Scale, Risk Analysis Index, modified frailty index, and Clinical Frail Scale . If cognition is not assessed via the screening tool selected, a separate cognitive screen may be beneficial . Patients are considered high risk if they are identified as prefrail or frail during screening; the entire perioperative team should be notified of and informed about these patients …”

Section: Screeningmentioning

confidence: 99%

“…When selecting a screening method, facilities should take into account the setting, limitations of the facility, patient population, and members of their team . Clayton suggested that the FRAIL scale may be a quick and easy screening option to implement because it uses a mnemonic, FRAIL (i.e., Fatigue, Resistance, Ambulation, Illnesses, Loss of weight), to guide the screening to determine a patient's level of frailty.…”

Section: Screeningmentioning

confidence: 99%

“…The number of Americans 65 years of age or older is projected to increase from 52 million in 2018 to 95 million by 2060 . As such, perioperative teams will be increasingly treating older patients . Frailty, which is defined as decreased function and short‐term resistance to stressors, is common in older adults .…”

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confidence: 99%

“…As such, perioperative teams will be increasingly treating older patients . Frailty, which is defined as decreased function and short‐term resistance to stressors, is common in older adults . It is considered to be more accurate than age for predicting morbidity and mortality …”

mentioning

confidence: 99%

“…In surgical patients, frailty is linked to poor outcomes and more complications, including higher rates of major illness, discharge to a rehabilitation facility, readmission, and death; greater length of hospitalization; and more emergency department visits . According to Judith L. Clayton, MSN, RN, CNOR, surgical services manager at St. Mary's Hospital, Athens, Georgia, it is essential that perioperative teams consider frailty when older patients present for surgery.…”

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confidence: 99%

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Preoperative management of frailty in older patients undergoing elective surgery

Croke¹

2019

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Section: Screeningmentioning

confidence: 99%

Section: Screeningmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Preoperative management of frailty in older patients undergoing elective surgery

Croke¹

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AORN Journal

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Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

et al. 2020

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IMPORTANCE Physical frailty is a key risk factor associated with higher rates of major adverse events (MAEs) after surgery. Assessing physical frailty is often challenging among patients with chronic limb-threatening ischemia (CLTI) who are often unable to perform gait-based assessments because of the presence of plantar wounds. OBJECTIVE To test a frailty meter (FM) that does not rely on gait to determine the risk of occurrence of MAEs after revascularization for patients with CLTI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 184 consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 individuals were excluded, 152 participants were included in the study. Data collection was conducted between May 2018 and June 2019. EXPOSURES Physical frailty measurement within 1 week before limb revascularization and incidence of MAEs for as long as 1 month after surgery. MAIN OUTCOMES AND MEASURES The FM works by quantifying weakness, slowness, rigidity, and exhaustion during a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of physical frailty. RESULTS Of 152 eligible participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) were unable to perform the gait test, while all could perform the FM test. Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI <0.20), prefrail (FI Ն0.20 to <0.35), or frail (FI Ն0.35), respectively. Within 30 days after surgery, 24 (15.7%) developed MAEs, either major adverse cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 [10.5%]). Baseline demographic characteristics were not significantly different between frailty groups. In contrast, the FI was approximately 30% higher in the group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, prefrail and frail groups, respectively (P = .004). The FI distinguished individuals who developed MACE and MALE from those who were MAE free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. CONCLUSIONS AND RELEVANCE In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for CLTI when the administration of gait-based tests is often challenging.

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Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

et al. 2021

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ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion.OBSERVATIONS Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low-and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCETo date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

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Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI)

Cited by 150 publications

References 58 publications

Preoperative management of frailty in older patients undergoing elective surgery

Preoperative management of frailty in older patients undergoing elective surgery

Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

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