Abstract
BackgroundAs the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the ‘older old’ and ‘oldest old’ surgical patients.MethodsA systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument.ResultsTwenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty.ConclusionThere was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that different frailty tools are best suited for different acuity and type of surgical patients. The association between frailty and return to pre-morbid function, discharge destination, and quality of life after surgery warrants further research.
Highlights
As the population ages, increasing numbers of older adults are undergoing surgery
This review provided insight into how frailty is measured and how it correlates with adverse outcomes in the ‘old-old’ and the ‘oldest old’ surgical population
Frailty is consistently found is to be associated with adverse outcomes after surgery
Summary
As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The rate of surgical procedures in the older population is rising. Women aged 85 years and over represent the largest proportion in emergency surgical admissions in Australia compared with all other age and sex groups [3]. It has long been recognised that advanced age can carry increased risk of mortality and morbidity after surgery. New knowledge is emerging that frailty, an age-related cumulative decline in multiple physiological systems, is a better predictor of mortality and morbidity than chronological age [4, 5]. The identification and assessment of frailty may facilitate identification of vulnerable surgical patients so that appropriate surgical and anaesthetic management can be implemented
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