Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI)

Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recomm...

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Bibliographic Details
Published in:Journal of clinical anesthesia Vol. 47; pp. 33 - 42
Main Authors: Alvarez-Nebreda, Maria Loreto, Bentov, Nathalie, Urman, Richard D., Setia, Sabeena, Huang, Joe Chin-Sun, Pfeifer, Kurt, Bennett, Katherine, Ong, Thuan D., Richman, Deborah, Gollapudi, Divya, Alec Rooke, G., Javedan, Houman
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.06.2018
Elsevier Limited
Subjects:
Activities of daily living
Age
Aged
Anesthesiology - methods
Anesthesiology - standards
Assessment
Elective Surgical Procedures - adverse effects
Evidence-Based Medicine - methods
Evidence-Based Medicine - standards
Female
Frail Elderly
Frailty
Frailty - diagnosis
Gender
Genotype & phenotype
Geriatrics
Humans
Male
Medical screening
Mortality
Nutrition
Outcomes
Patients
Perioperative Care - methods
Perioperative Care - standards
Postoperative Complications - etiology
Postoperative Complications - prevention & control
Preoperative
Prognosis
Quality control
Quality Improvement
Questionnaires
Risk Assessment - methods
Risk Assessment - standards
Screening
Sex Factors
Society
Variables
United States > US
Minnesota
Screening
Frailty
Preoperative
Outcomes
Assessment
Tool
ISSN:0952-8180, 1873-4529, 1873-4529
Online Access:Get full text
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Summary:Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery. These recommendations summarize evidence-based principles of measuring and screening for frailty, as well as basic interventions that can help improve patient outcomes. •The perioperative evaluation of elderly patients who require elective major surgery should include a frailty screen.•A positive frailty screen is best followed up with a diagnostic assessment of frailty and when feasible a comprehensive geriatric assessment•Multimodal prehabilitation programs could potentially improve the perioperative prognosis of frail patients.•Preoperative approach for frail older adults should be individualized.•Future studies should test the impact of various frailty interventions on system-centered and on patient-centered outcomes.
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ISSN:0952-8180
1873-4529
1873-4529
DOI:10.1016/j.jclinane.2018.02.011