Does frailty pose greater surgery risk?

Exploring whether frailty rather than age is a better predictor of recovery after an operation is the focus of a new Australian study.

How frail a person is, rather than their age, may be a better predictor of surgery complications and recovery, warn Australian anaesthetists.

Risks from surgery, including death, continue to decline in Australia. But as the population ages ensuring quality of life after an operation is a growing challenge for medical professionals.

"Although there has never been a safer time to have surgery and anaesthesia in history there's increasing challenges posed by elderly patients coming through," said Dr Jai Darvall, an anaesthetist at the Royal Melbourne Hospital.

Evidence is emerging that age is not the best predictor of how patients will recover after an operation, says Dr Darvall.

The intensive care specialist says frailty is one of the emerging areas of research interest - although hard to define.

In fact, a recent University of California San Francisco study published in journal JAMA Surgery found frailty of older patients getting ambulatory general surgery was tied to an increased risk of post-surgical complications independent of age.

A patient's frailty is probably best determined by the number of deficits they have, says Dr Darvall. These might include illness, problems with hearing or vision, and problems with mobility.

"Someone in their 40s and 50s can be frail and that's a challenge in hospitals because for a long time we have always looked at age as a major concern. Age is certainly important but you can have a fit and well robust 90-year-old who will pose much less risk than a frail 65-year-old."

Exploring whether frailty rather than age is a better predictor of recovery after an operation is the focus of a new Australian study, led by Dr Darvall.

The study will examine 250 patients aged 65 and over who are undergoing both elective and emergency surgery at the Royal Melbourne Hospital. After six months of follow-up, the data collected will be analysed and hopefully used to help develop a frailty index.

"If we can better identify these higher risk, frail patients we can work together as a health system before, during and after their operations to ensure the best outcomes for this vulnerable group," said Dr Darvall.

With people now aged 65 and over now making up 41 per cent of all hospital admissions the Australian and New Zealand College of Anaethetists (ANZCA) is encouraging older, frail patients to better prepare for their operation to reduce their risks of complications.

"The reality is we have an ageing population and that means more high-risk procedures are being undertaken in elderly and sometimes frail patients, said ANZCA President, Professor David A Scott.

KEY QUESTIONS OLDER PATIENTS SHOULD DISCUSS WITH ANAETHETIST

* How do medication conditions and medications affect anaethesia?

* Will my memory and thinking be affected by anaethesia?

* Is an operation the best option ?

* How can I prepare for my operation?

Source: SBS

Available at: http://www.sbs.com.au/news/article/2017/10/15/does-frailty-pose-greater-surgery-risk