Among 168 surveyed emergency surgeons, 98.2% agreed frailty influences outcomes, but only 1.2% used a specific frailty screening tool and 61.3% were unaware of the POPS model.
Cross-Sectional (n=168)
Despite high awareness of the importance of frailty in emergency surgery, formal frailty assessment is rarely performed due to lack of knowledge and trained staff.
BACKGROUND: Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons' awareness and perception of perioperative frailty management, and barriers to its implementation. METHODS: A qualitative cross-sectional survey was sent via the World Society of Emergency Surgery e-letter to their members. Responses were analysed using descriptive statistics and reported by themes: risk scoring systems, frailty awareness and assessment and barriers to implementation. RESULT: Of 168/1000 respondents, 38% were aware of the terms "Perioperative medicine for older people undergoing surgery" (POPS) and Comprehensive Geriatric Assessment (CGA). 66.6% of respondents assessed perioperative risk, with 45.2% using the American Society of Anaesthesiologists Physical Status Classification System (ASA-PS). 77.8% of respondents mostly agreed or agreed with the statement that they routinely conducted medical comorbidity management, and pain and falls risk assessment during emergency surgical admissions. Although 98.2% of respondents agreed that frailty was important, only 2.4% performed CGA and 1.2% used a specific frailty screening tool. Clinical frailty score was the most commonly used tool by those who did. Screening was usually conducted by surgical trainees. Key barriers included a lack of knowledge about frailty assessment, a lack of clarity on who should be responsible for frailty screening, and a lack of trained staff. CONCLUSIONS: Our study highlights the ubiquitous lack of awareness regarding frailty assessment and the POPS model of care. More training and clear guidelines on frailty scoring, alongside support by multidisciplinary teams, may reduce the burden on surgical trainees, potentially improving rates of appropriate frailty assessment and management of the frailty syndrome in emergency surgical patients.
Viswanath et al. (Wed,) conducted a cross-sectional in Perioperative management of frail emergency surgery patients (n=168). Perioperative frailty management practices was evaluated on Awareness and practices regarding frailty assessment and the POPS model. Among 168 surveyed emergency surgeons, 98.2% agreed frailty influences outcomes, but only 1.2% used a specific frailty screening tool and 61.3% were unaware of the POPS model.
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