Simon J G Richards1,2, Frank A Frizelle3,4, John A Geddes3, Tim W Eglinton3,4, Mark B Hampton3. 1. University of Otago, Christchurch, New Zealand. simon.richards@cdhb.heatlh.nz. 2. Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand. simon.richards@cdhb.heatlh.nz. 3. University of Otago, Christchurch, New Zealand. 4. Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand.
Abstract
OBJECTIVE: To describe the current definitions, aetiology, assessment tools and clinical implications of frailty in modern surgical practice. BACKGROUND: Frailty is a critical issue in modern surgical practice due to its association with adverse health events and poor post-operative outcomes. The global population is rapidly ageing resulting in more older patients presenting for surgery. With this, the number of frail patients presenting for surgery is also increasing. Despite the identification of frailty as a significant predictor of poor health outcomes, there is currently no consensus on how to define, measure and diagnose this important syndrome. METHODS: Relevant references were identified through keyword searches of the Cochran, MEDLINE and EMbase databases. RESULTS: Despite the lack of a gold standard operational definition, frailty can be conceptualised as a state of increased vulnerability resulting from a decline in physiological reserve and function across multiple organ systems, such that the ability to withstand stressors is impaired. Multiple studies have shown a strong association between frailty and adverse peri-operative outcomes. Frailty may be assessed using multiple tools; however, the ideal tool for use in a clinical setting has yet to be identified. Despite the association between frailty and adverse outcomes, few interventions have been shown to improve outcomes in these patients. CONCLUSION: Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.
OBJECTIVE: To describe the current definitions, aetiology, assessment tools and clinical implications of frailty in modern surgical practice. BACKGROUND: Frailty is a critical issue in modern surgical practice due to its association with adverse health events and poor post-operative outcomes. The global population is rapidly ageing resulting in more older patients presenting for surgery. With this, the number of frail patients presenting for surgery is also increasing. Despite the identification of frailty as a significant predictor of poor health outcomes, there is currently no consensus on how to define, measure and diagnose this important syndrome. METHODS: Relevant references were identified through keyword searches of the Cochran, MEDLINE and EMbase databases. RESULTS: Despite the lack of a gold standard operational definition, frailty can be conceptualised as a state of increased vulnerability resulting from a decline in physiological reserve and function across multiple organ systems, such that the ability to withstand stressors is impaired. Multiple studies have shown a strong association between frailty and adverse peri-operative outcomes. Frailty may be assessed using multiple tools; however, the ideal tool for use in a clinical setting has yet to be identified. Despite the association between frailty and adverse outcomes, few interventions have been shown to improve outcomes in these patients. CONCLUSION: Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.
Entities:
Keywords:
Elderly; Frailty; Post-operative outcomes; Surgery
Authors: G K Ambler; D E Brooks; N Al Zuhir; A Ali; M S Gohel; P D Hayes; K Varty; J R Boyle; P A Coughlin Journal: Br J Surg Date: 2015-03-12 Impact factor: 6.939
Authors: Brandon M Meyers; Humaid O Al-Shamsi; Sara Rask; Radhika Yelamanchili; Callista M Phillips; Alexandra Papaioannou; Gregory R Pond; Neera Jeyabalan; Kevin M Zbuk; Sukhbinder Kaur Dhesy-Thind Journal: J Gastrointest Oncol Date: 2017-02
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Madeleine Courtney-Brooks; A Rauda Tellawi; Jennifer Scalici; Linda R Duska; Amir A Jazaeri; Susan C Modesitt; Leigh A Cantrell Journal: Gynecol Oncol Date: 2012-04-19 Impact factor: 5.482
Authors: Patricia Torres-Perez; María Álvarez-Satta; Mariano Arrazola; Larraitz Egaña; Manuel Moreno-Valladares; Jorge Villanua; Irune Ruiz; Nicolas Sampron; Ander Matheu Journal: Am J Cancer Res Date: 2021-06-15 Impact factor: 6.166
Authors: Jennie Meier; Miles Berger; Timothy P Hogan; Joan Reisch; C Munro Cullum; Simon C Lee; Celette Sugg Skinner; Herbert Zeh; Cynthia J Brown; Courtney J Balentine Journal: J Surg Res Date: 2021-05-11 Impact factor: 2.417
Authors: Zoltán Kovács-Ábrahám; Timea Aczél; Gábor Jancsó; Zoltán Horváth-Szalai; Lajos Nagy; Ildikó Tóth; Bálint Nagy; Tihamér Molnár; Péter Szabó Journal: J Clin Med Date: 2021-11-23 Impact factor: 4.241
Authors: Yoon Penning; Antoine El Asmar; Michel Moreau; Julie Raspé; Lissandra Dal Lago; Thierry Pepersack; Vincent Donckier; Gabriel Liberale Journal: PLoS One Date: 2022-03-03 Impact factor: 3.240