Preadmissions Management service (PreAMS) for preoperative assessment of frail elderly patients undergoing elective surgery at University Hospital of North Midlands

Introduction:

There are an increasing number of older adults undergoing elective surgery, with frailty being a stronger predictor of post-operative outcomes.

The Pre-AMS frailty clinic was set up to evaluate frail patients undergoing elective surgery within the broader Preoperative Assessment Clinic (POAC) pathway.

Through Comprehensive Geriatric Assessment (CGA), the Pre-AMS clinic evaluates frailty, multi-morbidity, cognition, poly-pharmacy, and functional status. 

This face to face, interactive joint assessment by anaesthetist and geriatricians with patients and families help early identification of modifiable risks, optimisation of medical conditions and supports improved surgical decision-making, individualised care planning and prevention of complications. 

Pre-AMS Audit is a data-informed evaluation of the Pre-AMS frailty service in perioperative care for older adults.

Method: 

A retrospective audit of patients from the Pre-AMS frailty prior to elective surgery, with prospective follow-up of post-operative outcomes.

Data was extracted from electronic patient records over the audit period.

Data included:

Demographics, BMI, co-morbidities, frailty score, investigations, speciality input. Surgical procedure type, anaesthesia, proceed/did not proceed/cancel status). Outcomes (length of stay, complications, 30-day mortality)

Results:

• Data period:  05/07/2023 – 30/06/2025
• Sample size: 54 patients 
• Male:Female 22:32
• Average age: 81.7   
• 31 (57%) Proceeded with operation
• 16 (29%) Did not proceed due to change in clinical condition or deemed very high risk. 3 patients died of other conditions.
• 5 (9%) cancelled surgery by own choice
• 2 (5%) awaiting surgery
• 1 (2%) had significant post-operative complications (AKI)
• 30-day post-operative mortality was nil
• 11 (20%) required specialist input: cardiac device intervention, haematology, renal.
• 19 (35%) required optimisation of diuretics, diabetes, cardiac drugs, nutrition, haematinics and pain management.
• 30 (55%) required pre-op investigations like lung function tests, echo,holter,imaging.

Conclusion:

• The Pre-AMS frailty clinic identified patients requiring investigations, medication optimisation and guided appropriate patient selection for surgery.
• Majority of suitable patients proceed safely for surgery.
• Low complication rate suggested benefit of preoperative assessments and interventions.