Abstract
Introduction: With an ageing population, identifying frailty aids reduction of adverse postoperative outcomes. Centre for Perioperative Care - British Geriatrics Society ‘Care for People Living with Frailty’ guidelines state all patients aged >65 should have a documented Clinical Frailty Scale (CFS) score at pre-operative assessment. If CFS≥5, cognitive assessment should be documented and Comprehensive Geriatric Assessment performed. This audit aimed to assess frailty documentation at pre-operative anaesthetic assessment to support introduction of a specialist perioperative frailty pathway.
Method: Patients attending pre-operative anaesthetic assessment at a teaching hospital (large DGH) between October and December 2024 were screened. Patients aged >65 undergoing elective major surgery were included. Major surgery was defined by Surgical Outcome Risk Tool v2. Anaesthetic clinic letters were reviewed for documented CFS score and cognitive assessment. Demographics, CFS score documentation & value and cognitive assessment documentation were collected. Decision on suitability for surgery, length of stay and mortality were collected for CFS≥5.
Results: 230 patients were screened, with 86 patients included. Median age was 76 (IQR 72-82), 58% were male (n=50). 24% (n=21) of patients had a documented CFS score. 57% (n=12) of documented CFS scores were ≥5. No patients with CFS≥5 had a cognitive assessment documented. 42% (n=5) of patients with CFS≥5 were considered unsuitable for surgical options upon shared decision-making with patients regarding risks vs benefits.
Conclusions: High levels of frailty exist in pre-operative clinic, which may be further underestimated by inconsistent documentation. Identifying perioperative frailty is essential to optimise patient risk factors and initiate shared decision-making conversations. This data supports introduction of a specialist perioperative frailty pathway. A second cycle will audit the effectiveness of this.
Comments
Were you able to verify…
Were you able to verify/check that the patient's documented CFS score was correct?
Hello,
Thank you very much…
Hello,
Thank you very much for your question.
We reviewed clinical letters for patients who attended the consultant-led pre-operative anaesthetic assessment clinic therefore all CFS scores were assigned by the consultant anaesthetist. The clinical letters included written content that could be used to support the CFS score assigned, however we did not specifically collect data regarding verifying the score assigned so this is something we can look to incorporate when we come to re-audit our service.