CPOC: Frailty Patients Undergoing Elective and Emergency Surgery

Question 1

Frailty definition

Answer 1

A multidomain decline in physiological reserve and function resulting in an increased vulnerability to stressors.

Question 2

CPOC Recommendations for Frailty

Answer 2

• Any patient >65yrs and younger if at risk of frailty referred for surgery should have a clinical frailty score documented
• Anyone with a clinical frailty score >4 should undergo a comprehensive geriatric assessment tailored to the type of surgery and its urgency

Question 3

Common conditions that co-exist with frailty

Answer 3

• Sarcopenia
• Malnutrition
• Multimorbidity
• Cognitive impairment

Question 4

Preoperative considerations for frailty

Answer 4

• Assess and document frailty (clinical frailty score)
• Refer to frailty team for comprehensive geriatric assessment
• Establish escalation plans/ DNACPR/ LPA
• Undertake shared decision making re options including non-operative

Question 5

Intraoperative considerations for frailty

Answer 5

• Consultant surgeon and anaesthetist in high-risk cases
• Identify frailty and comorbidities at team brief
• Ensure physiological homeostasis

Question 6

Postoperative considerations for frailty

Answer 6

• Anticipate prevent and treat: delirium, pain, hospital-acquired deconditioning
• Review treatment escalation plans
• Promote recovery, mobilisation, E&D

Question 7

Tools for assessing cognitive impairment

Answer 7

4AT, mini-Cog, Montreal cognitive assessment

Question 8

Tools for assessing functional capacity

Answer 8

Self-reported exercise tolerance (DASI), six-minute walk test, CPET, stairs test

Question 9

Tools for assessing nutrition

Answer 9

MUST, patients association nutrition checklist

Question 10

Tools for assessing mood

Answer 10

HADS, geriatric depression scale