Abstract Introduction With an ageing global population, an increasing number of older adults are undergoing surgery. Frailty and cognitive dysfunction are common in this demographic and are associated with poorer perioperative outcomes. Current Centre for Perioperative Care (CPOC) guidelines recommend that all patients aged 65 and over have a Clinical Frailty Scale (CFS) documented and those with CFS ≥5 should undergo cognitive screening and appropriate optimisation. There is growing evidence supporting comprehensive preoperative assessment models for this vulnerable cohort, incorporating physical conditioning, polypharmacy, and co-morbidity management to support informed surgical decision-making. We evaluated whether our current nurse-led pre-operative assessment (POA) clinics are meeting these criteria. Methods A retrospective review was conducted on 100 patients aged over 65 who attended a POA clinic at a London tertiary centre between September and November 2024. Data collected included CFS, Six-Item Cognitive Impairment Test (6CIT) scores, Charlson Comorbidity Index, and polypharmacy status. Documented CFS scores were reviewed for accuracy by a senior (ST5+) geriatrician. Results Of the 100 patients, 59% were female, with a mean age of 74.9 years. CFS was documented in 66% of cases. Amongst these, 33% were inaccurately scored—20% underestimated frailty, while 13% overestimated it. Seventeen percent of patients had a CFS ≥5, yet only 5% underwent cognitive screening with 6CIT. Polypharmacy (≥5 medications) was present in 64% of patients. Conclusion Our findings indicate that current practices are not meeting CPOC recommendations. A significant proportion of patients are frail and could benefit from targeted perioperative interventions to reduce morbidity and mortality. We are working collaboratively with the POA team to improve awareness and implementation of frailty and cognitive screening tools. Further research is required to assess outcomes and inform service development, with the goal of enhancing patient care, satisfaction, and institutional cost-effectiveness.
Ma et al. (Wed,) studied this question.