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Perioperative frailty: lessons learned and future directions.
Ibukunoluwa Adeleke1, Jeanna Blitz2
1Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Current Opinion in Anaesthesiology
|April 14, 2021
Summary
Preoperative frailty assessment and interventions are crucial for the aging surgical population. Multidimensional approaches, including nutrition and exercise, can mitigate frailty and improve surgical outcomes.
Area of Science:
- Geriatric Medicine
- Surgical Optimization
- Patient Vulnerability
Background:
- The aging surgical population necessitates improved preoperative assessment and management of frailty.
- Frailty is a complex syndrome with various conceptual frameworks and validated assessment tools for perioperative use.
Purpose of the Study:
- To review current conceptualizations of frailty.
- To present a practical approach to preoperative frailty assessment.
- To highlight potential interventions for frail surgical patients.
Main Methods:
- Literature review of current conceptual frameworks and interventions for frailty.
- Focus on practical, multidimensional preoperative assessment strategies.
- Emphasis on patient-specific interventions.
Main Results:
- A multipronged approach is recommended for preoperative optimization of frail patients.
- Nutritional support (oral protein, immunonutrition) can reduce complications.
- Preoperative exercise, nonpharmacologic interventions (anxiety/mood management), and shared decision-making are effective adjuncts.
- These interventions are associated with improved postoperative outcomes.
Conclusions:
- Emerging evidence supports the mitigation of frailty through patient-specific, multidimensional preoperative interventions.
- Optimizing frail patients preoperatively holds potential for improved postoperative outcomes in this vulnerable group.
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