Frailty represents a state of increased vulnerability to peri-operative stressors, and quantifying it using tools like the Frailty Index may increase the precision of peri-operative risk assessment.
How does patient frailty affect peri-operative outcomes and how should it be measured?
Systematic quantification of frailty, rather than subjective assessment, is necessary to accurately assess peri-operative risk in older patients.
For most surgeons and many anaesthetists, patient frailty is currently the 'elephant in the (operating) room': it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri-operative outcomes. We explore the limitations of 'eyeballing' patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri-operative setting. Quantifying frailty is likely to increase the precision of peri-operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the pre-operative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research.
Hubbard et al. (Thu,) conducted a review in Patient frailty in the peri-operative setting. Frailty assessment was evaluated. Frailty represents a state of increased vulnerability to peri-operative stressors, and quantifying it using tools like the Frailty Index may increase the precision of peri-operative risk assessment.