Abstract
BackgroundFrailty is an important prognostic factor for adverse outcomes and increased resource use in the growing population of older surgical patients. We identified and appraised studies that tested interventions in populations of frail surgical patients to improve perioperative outcomes.MethodsWe systematically searched Cochrane, CINAHL, EMBASE and Medline to identify studies that tested interventions in populations of frail patients having surgery. All phases of study selection, data extraction, and risk of bias assessment were done in duplicate. Results were synthesized qualitatively per a prespecified protocol (CRD42016039909).ResultsWe identified 2 593 titles; 11 were included for final analysis, representing 1 668 participants in orthopedic, general, cardiac, and mixed surgical populations. Only one study was multicenter and risk of bias was moderate to high in all studies. Interventions were applied pre- and postoperatively, and included exercise therapy (n = 4), multicomponent geriatric care protocols (n = 5), and blood transfusion triggers (n = 1); no specific surgical techniques were compared. Exercise therapy, applied pre-, or post-operatively, was associated with significant improvements in functional outcomes and improved quality of life. Multicomponent protocols suffered from poor compliance and difficulties in implementation. Transfusion triggers had no significant impact on mortality or other outcomes.ConclusionsDespite a growing literature that demonstrates strong independent associations between frailty and adverse outcomes, few interventions have been tested to improve the outcomes of frail surgical patients, and most available studies are at substantial risk of bias. Multicenter, low risk of bias, studies of perioperative exercise are needed, while substantial efforts are required to develop and test other interventions to improve the outcomes of frail people having surgery.
Highlights
Western populations are aging rapidly.[1,2] Older people have surgery at over two times the rate of younger individuals,[3] and advanced age is a well-established risk factor for adverse postoperative outcomes.[4,5] amongst the older surgical population, outcomes vary substantially.[6]
Interventions for frail surgical patients of frail surgical patients, and most available studies are at substantial risk of bias
A state of increased vulnerability to stressors due to age, and diseaserelated deficits that accumulate across multiple domains, is a key factor in explaining the increased rates of complications, healthcare resource use, loss of independence, and mortality experienced by older surgical patients[7,8,9,10,11]
Summary
Western populations are aging rapidly.[1,2] Older people have surgery at over two times the rate of younger individuals,[3] and advanced age is a well-established risk factor for adverse postoperative outcomes.[4,5] amongst the older surgical population, outcomes vary substantially.[6]. Despite the strong and increasingly well-recognized association of frailty with adverse postoperative events and increased resource use across surgical specialties,[8,9,17] and the multitude of instruments that have been used to diagnose frailty,[18] interventions tailored to frail surgical patients are not commonly described in the literature, and have not been systematically reviewed. Knowledge generated from such a synthesis is needed to inform current care and future research. We identified and appraised studies that tested interventions in populations of frail surgical patients to improve perioperative outcomes
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