Frailty and anesthesia - risks during and post-surgery

Hui-Shan Lin, Rebecca L McBride, Ruth E Hubbard, Hui-Shan Lin, Rebecca L McBride, Ruth E Hubbard

Abstract

Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.

Keywords: adverse outcomes; elderly; frail; perioperative medicine; surgery.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Role of frailty in recovery from surgery. Source: Copyright ©1999–2018 John Wiley & Sons, Inc. Reproduced from Desserud KF, Veen T, Soreide K. Emergency general surgery in the geriatric patient. Br J Surg. 2016; 103(2):e52–61. from Desserud et al.
Figure 2
Figure 2
Publications on frailty and surgical outcomes since year 2010.

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