TY - JOUR
T1 - Preoperative frailty assessment combined with prehabilitation and nutrition strategies
T2 - Emerging concepts and clinical outcomes
AU - Gritsenko, Karina
AU - Helander, Erik
AU - Webb, Michael P.K.
AU - Okeagu, Chikezie N.
AU - Hyatali, Farees
AU - Renschler, Jordan S.
AU - Anzalone, Fallon
AU - Cornett, Elyse M.
AU - Urman, Richard D.
AU - Kaye, Alan D.
N1 - Publisher Copyright:
© 2020
PY - 2020/6
Y1 - 2020/6
N2 - Important elements of the preoperative assessment that should be addressed for the older adult population include frailty, comorbidities, nutritional status, cognition, and medications. Frailty has emerged as a plausible predictor of adverse outcomes after surgery. It is present in older patients and is characterized by multisystem physiologic decline, increased vulnerability to stressors, and adverse clinical outcomes. Preoperative preparation may include a prehabilitation program, which aims to address nutritional insufficiencies, modify chronic polypharmacy, and enhance physical and respiratory conditions prior to hospital admission. Special considerations are taken for particularly high-risk patients, where the approach to prehabilitation can address specific, individual risk factors. Identifying patients who are nutritionally deficient allows practitioners to intervene preoperatively to optimize their nutritional status, and different strategies are available, such as immunonutrition. Previous studies have shown an association between increased frailty and the risk of postoperative complications, morbidity, hospital length of stay, and 30-day and long-term mortality following general surgical procedures. Evidence from numerous studies suggests a potential benefit of including a standard assessment of frailty as part of the preoperative workup of older adult patients. Studies addressing validated frailty assessments and the quantification of their predictive capabilities in various surgeries are warranted.
AB - Important elements of the preoperative assessment that should be addressed for the older adult population include frailty, comorbidities, nutritional status, cognition, and medications. Frailty has emerged as a plausible predictor of adverse outcomes after surgery. It is present in older patients and is characterized by multisystem physiologic decline, increased vulnerability to stressors, and adverse clinical outcomes. Preoperative preparation may include a prehabilitation program, which aims to address nutritional insufficiencies, modify chronic polypharmacy, and enhance physical and respiratory conditions prior to hospital admission. Special considerations are taken for particularly high-risk patients, where the approach to prehabilitation can address specific, individual risk factors. Identifying patients who are nutritionally deficient allows practitioners to intervene preoperatively to optimize their nutritional status, and different strategies are available, such as immunonutrition. Previous studies have shown an association between increased frailty and the risk of postoperative complications, morbidity, hospital length of stay, and 30-day and long-term mortality following general surgical procedures. Evidence from numerous studies suggests a potential benefit of including a standard assessment of frailty as part of the preoperative workup of older adult patients. Studies addressing validated frailty assessments and the quantification of their predictive capabilities in various surgeries are warranted.
KW - adverse outcomes
KW - geriatric
KW - nutrition
KW - preoperative frailty
KW - total parenteral nutrition
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U2 - 10.1016/j.bpa.2020.04.008
DO - 10.1016/j.bpa.2020.04.008
M3 - Review article
C2 - 32711829
AN - SCOPUS:85085342392
SN - 1521-6896
VL - 34
SP - 199
EP - 212
JO - Best Practice and Research: Clinical Anaesthesiology
JF - Best Practice and Research: Clinical Anaesthesiology
IS - 2
ER -