Frailty Progression on General Surgical Waiting Lists: Does POPS Intervention Make a Difference?

Introduction

Frailty is associated with adverse surgical outcomes1. Prolonged surgical waiting lists risk progression of frailty in older adults. This study evaluated changes in clinical frailty scale (CFS) over 12 months among individuals remaining on a surgical waiting list and explored whether involvement of a geriatrician led Perioperative care for Older People undergoing Surgery (POPS) team influenced frailty progression.

Methods

Patients over 65 years of age on a single trust general surgical waiting list were asked to self-report their CFS via a digital platform. Patients with CFS score ≥4 were offered appointments with a dedicated perioperative frailty service. Patients who remained on the surgical waiting list after 12 months were asked to re-score themselves, with or without being seen by the frailty service. The primary outcome was change in CFS (12-month minus baseline).

Results

Sixty-six patients met inclusion criteria (29 seen by POPS; 37 not seen). At baseline, those seen by POPS were more frail (mean CFS 5.03 vs 2.78). Over 12 months, the POPS group demonstrated a mean improvement of −0.45 points (Wilcoxon p = 0.061), whereas the not-seen group worsened by +0.41 points (Wilcoxon p = 0.776). Between-group comparison confirmed a significant difference in change (Mann–Whitney U p = 0.003).

Conclusions

This retrospective study demonstrates the benefits of POPS involvement on frailty progression for older people on long surgical waiting lists. On average those seen by POPS showed a small improvement in CFS compared to those who were not, despite higher baseline frailty. These findings suggest that perioperative geriatric input may mitigate frailty progression during prolonged waits, supporting integration of POPS into elective surgical pathways2.

References

1. Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP. Frailty as a predictor of surgical outcomes in older patients. Journal of American College Surgery. 2010 Jun;210(6):901-8. doi: 10.1016/j.jamcollsurg.2010.01.028. Epub 2010 Apr 28. PMID: 20510798.
2. Partridge, J., Dhesi, J., & Selwyn, D. (2021). Guideline for Perioperative Care for People Living with Frailty Undergoing Elective and Emergency Surgery. Centre for Perioperative Care.