Ashwin Subramaniam1,2, Ravindranath Tiruvoipati2,3, Margot Lodge2,4, Christopher Moran2,4,5,6, Velandai Srikanth2,6,7. 1. Department of Intensive Care, Frankston Hospital and The Bays Hospital, Melbourne, Victoria, Australia. 2. Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia. 3. Department of Intensive Care, Frankston Hospital and Peninsula Private Hospital, Melbourne, Victoria, Australia. 4. Department of Aged Care, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia. 5. Department of Medicine, Peninsula Health, Melbourne, Victoria, Australia. 6. Department of Geriatric Medicine, Peninsula Health, Melbourne, Victoria, Australia. 7. Acute Care of the Elderly, Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Abstract
BACKGROUND: The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post-operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. METHODS: Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. RESULTS: We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. CONCLUSION: Establishing multidisciplinary collaborative services to provide person-centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large-scale studies should focus on implementing and evaluating such multicomponent models of care.
BACKGROUND: The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post-operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. METHODS: Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. RESULTS: We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. CONCLUSION: Establishing multidisciplinary collaborative services to provide person-centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large-scale studies should focus on implementing and evaluating such multicomponent models of care.
Authors: Patrick J Smith; Meagan Lew; Yen Lowder; Kristi Romero; Jillian C Thompson; Lauren Bohannon; Alyssa Pittman; Alexandra Artica; Sendhilnathan Ramalingam; Taewoong Choi; Cristina Gasparetto; Mitchell Horwitz; Gwynn Long; Richard Lopez; David Rizzieri; Stefanie Sarantopoulos; Keith Sullivan; Nelson Chao; Anthony D Sung Journal: Bone Marrow Transplant Date: 2021-10-19 Impact factor: 5.483
Authors: Qi Yan; Jeongsoo Kim; Daniel E Hall; Myrick C Shinall; Katherine Moll Reitz; Karyn B Stitzenberg; Lillian S Kao; Elizabeth L George; Ada Youk; Chen-Pin Wang; Jonathan C Silverstein; Elmer V Bernstam; Paula K Shireman Journal: Ann Surg Date: 2021-06-25 Impact factor: 12.969