The implication of frailty on preoperative risk assessment

Abstract

Purpose of Review Frailty, a state of decreased homeostatic reserve, is characterized by dysregulation across multiple physiologic and molecular pathways. It is particularly relevant to the perioperative period, during which patients are subject to high levels of stress and inflammation. This review aims to familiarize the anesthesiologist with the most current concepts regarding frailty and its emerging role in preoperative assessment and risk stratification. Recent findings Current literature has established frailty as a significant predictor of operative complications, institutionalization, and death among elderly surgical patients. A variety of scoring systems have been proposed to preoperatively identify and assess frail patients, though they differ in their clinical utility and prognostic ability. Additionally, evidence suggests an evolving potential for preoperative intervention and modification of the frailty syndrome. Summary The elderly are medically complex and heterogeneous with respect to operative risk. Recent advances in the concept of frailty provide an evidence-based framework to guide the anesthesiologist in the perioperative management, evaluation, and risk stratification of older surgical patients.

Frailty syndrome and pre-operative risk evaluation: A systematic review

“…Therefore, various scoring systems have been used (see Table 4). Although each of these scales efficiently identifies individuals with a high risk of adverse outcomes, they have analysed different subpopulations and differ in their ability to predict the prognostic outcomes (Amrock & Deiner, 2014).…”

Impact of frailty on surgical outcomes: The right patient for the right procedure

“…Even though frailty remains an ethereal concept, most investigators define frailty as a decrease in physiologic reserve of multiple organ systems with identifiable altered physical function beyond what is expected for normal aging. 1,2,[7][8][9] To date, there is no clear consensus on the optimal method to measure frailty. 9 However, attempts to measure frailty have fallen largely into 2 categories: deficit accumulation and phenotypic measures.…”

“…1,2,[7][8][9] To date, there is no clear consensus on the optimal method to measure frailty. 9 However, attempts to measure frailty have fallen largely into 2 categories: deficit accumulation and phenotypic measures. 1,2,10,11 Deficit accumulation accounts for cumulative deficits accrued across multiple domains such as ability to perform activities of daily living, mini-cognition test, and falls.…”

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

“…9,21 While it is a common end point to human senescence, this process is pathological and has been shown to be associated with adverse outcomes after surgery. 1,5,14 Unfortunately, measuring human frailty relies on subjective assessments and prolonged patient cooperation, which is impractical in application. 1,14 Surrogate markers of frailty, such as sarcopenia, may be more useful to clinicians.…”

“…1,5,14 Unfortunately, measuring human frailty relies on subjective assessments and prolonged patient cooperation, which is impractical in application. 1,14 Surrogate markers of frailty, such as sarcopenia, may be more useful to clinicians. Morphometrics is the measurement of patient attributes that are indicative of sarcopenia and thus frailty by proxy.…”