Research conducted by the Royal College of Anaesthetists (RCoA) and the University of Nottingham indicates that nearly three-quarters (71%) of hospitals in the UK do not routinely screen older surgical patients aged 60 and over for frailty.
This is despite evidence that frailty significantly increases the risk of complications, such as longer hospital stays, delirium and even death.
One in five (19.6%) surgical patients over the age of 60 live with frailty – a condition that can result in slower recovery from illness or injury.
Many patients who are affected may be unaware that they have the condition or how it can impact their recovery from surgery.
The researchers recommend that all patients over 60 be assessed for frailty before surgery as standard practice, so that their care can be managed with involvement from a geriatrician where appropriate.
The research, published in the British Journal of Anaesthesia, originates from the RCoA’s third Sprint National Anaesthesia Project (SNAP3), the most comprehensive study on frailty and multimorbidity in UK surgical patients to date, and includes data from 7,134 patients across 263 NHS hospitals, collected over five consecutive days in March 2022.
Individuals experiencing frailty are less likely to achieve a good recovery after an operation, and the risks increase with the degree of frailty. When compared to patients who are not frail, individuals living with frailty:
• Stay an average of three days longer in hospital after an operation, increasing to six days longer for those who are severely frail
• Are three times more likely to have complications from surgery
• Are four times more likely to have delirium following surgery, a condition that causes confusion
• Are three times more likely to die within one year of surgery.
Individuals living with frailty may observe that they feel slower, weaker, or more fatigued. They might also notice muscle loss, unintended weight loss, and a greater need for assistance with daily activities.
The Clinical Frailty Scale (CFS) is an accessible tool that healthcare professionals can utilise to determine whether a person is experiencing frailty. A CFS score of 5 or above indicates frailty and should prompt a referral to a geriatrician for specialist care.
Identifying patients who are living with frailty assists healthcare professionals in discussing personalised treatment options.
This incorporates realistic discussions about the likelihood of survival and of maintaining independence after the operation. It also assists hospitals in reducing risks, enhancing recovery, and delivering appropriate support post-surgery.
However, these discussions can only occur if frailty has been identified. Research indicates that in nearly three-quarters (71%) of cases, UK hospitals are not routinely screening for frailty.
This collaborative study, conducted by anaesthetists from nearly every hospital in the UK, has highlighted the prevalence of frailty in older people undergoing surgery. Identifying frailty is straightforward and should lead to open and honest discussions with patients about what can be offered, what they want and what they can expect if they choose to have surgery.
Dr Claire Shannon, President of the Royal College of Anaesthetists, said: ‘This research provides evidence that patients living with frailty are more likely to experience complications from surgery, such as longer hospital stays and delirium. There is huge potential to improve patient outcomes by assessing all those over 60 for frailty as standard practice so that their care can be managed appropriately, with involvement from a geriatrician.’
