Perioperative Acute Care of Older Patients Living with Frailty

Abstract

Frailty has been independently linked to adverse postoperative outcomes including increased morbidity, mortality, health resource use, and disability. We discuss the data underlying these associations, as well as literature supporting perioperative frailty assessment and perioperative management strategies, with a focus on older people with frailty undergoing elective, non-cardiac surgery. Perioperative interventions tested to improve outcomes for older people with frailty are limited; interventions proven to improve outcomes are even more rare. Current evidence-based strategies include exercise therapy, preoperative identification and communication of frailty status, and multidisciplinary geriatric focused care. No specific intraoperative strategy exists to impact outcomes for people with frailty. Older people with frailty are vulnerable to adverse outcomes following surgery. However, significant knowledge gaps exist with respect to encouraging routine assessment of frailty and development of effective perioperative interventions. Anesthesiologists are uniquely poised to facilitate the multidisciplinary perioperative care of frail patients. High-quality trials are needed to elucidate patient-centered outcomes, risk prediction, shared decision-making, and individualized perioperative interventions in older patients with frailty.