Perioperative Frailty: The need for a novel and collaborative approach

Abstract

Ireland has an ageing population, and over the next 30 years the number of people aged 65 years and over is expected to double (CSO Figures). Increasing numbers of older people are undergoing surgery. Indeed, the surgical population is ageing at a faster rate than the general population and it is estimated that by 2030 one fifth of surgical candidates will be over the age of 75. In Ireland, we know that about 25% of this over 75 cohort is frail. Frailty is a distinctive syndrome related to, but not exclusively associated with, ageing in which decreased resilience across multiple systems leads to an increased vulnerability to external stressors, resulting in a slower or indeed incomplete recovery following a physiological challenge, including surgery. Multiple studies in the perioperative setting have identified frailty to be independent predictor of adverse clinician reported, patient reported and process related outcomes. Frailty is a measurable clinical syndrome and, importantly, is a modifiable state. Identifying those with, and those at risk of, frailty allows for the application of targeted interventions which can minimise the clinical impact of this syndrome. However, many perioperative pathways neither identify frailty nor intervene, and represent a missed opportunity.

We noted with interest the recently published Sprint National Audit Project (SNAP) 3 data which provides granular detail about the prevalence and clinical impact of frailty on outcomes after surgery in the older cohort.