How Frailty Amplifies Postoperative Risk
Frailty is frequently observed in older adults.[1] Different from disability per se, frailty is associated with low physiologic reserve related to age and underlying chronic disease.[2] It is seen in patients with unintentional weight loss, documented muscle weakness, reduced speed of walking, low physical activity, and a sense of easy exhaustion.[1] Frailty occurs in approximately 7% of adults older than 65 years and increases the risk for early mortality compared with elderly patients who lack measurable frailty.
Frailty is associated with increased vulnerability in clinical response to acute healthcare events and increased surgical morbidity after common ambulatory or 23-hour-stay surgical operations (eg, hernia repair or breast, thyroid, or parathyroid surgery), and it is independent of patient age alone.[2] As frailty progresses, there is an even greater risk for postsurgical complications. One study of frail patients undergoing elective surgery identified it as an independent predictor of postoperative complications resulting in longer postsurgical hospital stays and more dismissals to skilled nursing facilities for postprocedure rehabilitation.[3] Even a procedure as seemingly simple as tracheostomy is associated with greater mortality in such patients.[4]
There is a need to recognize, measure, and reverse frailty before elective surgical procedures. Recognition of preoperative frailty can reduce postoperative mortality after careful preoperative assessment and optimization of perioperative care.
