Recent research published today in JAMA Surgery shows that when frail patients are connected to resources, including conversations with a physician about possible outcomes and help preparing their body for surgery, they’re less more likely to die one yr after surgery.

While age might be a very important indicator of a patient’s likelihood of encountering antagonistic outcomes or complications of surgery, it doesn’t provide a full picture of their health. Frailty considers the patient’s overall well-being, including their physical and cognitive abilities, in addition to their body’s ability to get better from surgery.

Frailty is a very strong predictor of postoperative outcomes. Frailty might be considered having low physiologic reserve. Surgeries and other stressors can deplete this reserve, potentially resulting in catastrophic outcomes like lack of independence or death.”

Daniel Hall, M.D., corresponding creator of the study and associate professor of surgery, University of Pittsburgh School of Medicine

The study checked out over 50,000 patients across five UPMC hospitals who were scheduled to undergo a serious surgery. Before meeting their surgeons, patients accomplished a temporary survey to evaluate frailty, and a medical assistant entered the rating into the electronic health record. For the 1,300 patients who met the factors to be considered frail, the record prompted the surgeon to either have one other conversation with the patient about possible frailty-associated antagonistic outcomes of the procedure or direct the patient to other resources, comparable to their primary care physician or UPMC’s Center for Perioperative Care.

After following these patients for a yr, Hall and his team discovered that patients who were identified as frail and connected to any additional resources were 18% less more likely to die one yr after their surgery.

One explanation for this reduction in risk is that patients took advantage of those resources to make healthy lifestyle changes, comparable to managing their weight or quitting smoking. One other explanation is that some patients who discussed possible antagonistic outcomes with a physician can have chosen to not proceed with their surgery.

“As clinicians, we sometimes make the final assumption that that which might be done, must be done,” Hall said. “By discussing the possible antagonistic outcomes with their doctor, patients may select a nonoperative management technique to get their condition under control without the possible risks of surgery. This intervention allows for higher goal clarification, higher alignment of treatment plans with patient goals and higher shared decision-making.”

Further studies are needed to find out which interventions have the largest impact on patient outcomes, in addition to adapt these screenings to other practice settings.

Source:

Journal reference:

Varley, P.R., et al. (2023) Association of Routine Preoperative Frailty Assessment With 1-12 months Postoperative Mortality. JAMA Surgery. doi.org/10.1001/jamasurg.2022.8341.