Frailty in the perioperative setting: lessons from SNAP-3

Area of Science:

• Geriatric Medicine
• Perioperative Care
• Surgical Outcomes

Background:

• The Sprint National Anaesthesia Project (SNAP-3) is the largest UK prospective, multicentre study investigating frailty, multimorbidity, and delirium in surgical patients aged 60 years and older.
• The study enrolled 7134 patients across 214 National Health Service (NHS) hospitals over five days in March 2022.

Discussion:

• Frailty, identified in one-fifth of patients using tools like the Clinical Frailty Scale (CFS), was particularly common in emergency surgery and socioeconomically deprived groups.
• While two-thirds of patients had multimorbidity, it only partially overlapped with frailty.
• Frailty showed a strong association with increased length of stay, delirium, complications, and mortality, with outcomes worsening with higher CFS scores.

Key Insights:

• Multimorbidity alone, without frailty, had a limited impact on most adverse outcomes.
• Directed acyclic graphs were used for causal analysis, though potential underestimation of multimorbidity's impact exists due to independence assumptions.
• The findings underscore the critical need for routine perioperative frailty screening and enhanced perioperative services.

Outlook:

• Data from SNAP-3 will guide service planning and prioritize frailty-focused care, especially in high-burden specialties and deprived areas.
• Workforce development is essential to support comprehensive perioperative care for frail patients.
• Future research may explore the complex interplay between frailty and multimorbidity more deeply.