Right Surgery, at the Right Time, for the Right Patient: A 5 Year Review Of The Perioperative Frailty MDT For Urology Patients
Abstract
Frailty is known to increase rate of post-operative complications, acquired geriatric syndromes, mortality and loss of independence. Despite this, almost three-quarters of UK hospitals are not routinely screening surgical patients >60 years for frailty. At Whipps Cross Hospital, we established a perioperative frailty MDT for urological patients in May 2021. Our project reviews the outcomes of this MDT over the past 5 years
Method
MDT and urological notes were retrospectively reviewed for all patients discussed in the frailty MDT from May 2021 - April 2026. Data on the MDT outcomes, actual outcomes and any complications were recorded.
Results
A total of 237 patients were discussed over 5 years. They had an average age of 82 and an average clinical frailty score of 5.4. MDT patient outcomes:
- 12% were removed from the surgical listing
- 19% were referred for further risk discussions (45% of these opted to be removed from the waiting list)
- 37% could proceed as listed
- 11% needed optimisation prior to proceeding
- 11% were scheduled for a less invasive procedure under LA
Out of 118 surgeries which occurred in the 5 years:
Only 3 patients suffered a hospital-acquired geriatric syndrome (delirium or deconditioning).
12 suffered a urological complication (mainly haematuria or infection)
7 suffered an anaesthetic complication (mainly cardiac or respiratory failure)
There were only 5 on the day cancellations.
Conclusion(s)
The perioperative frailty MDT has been key in identifying patients at high-risk of unnecessary procedures and/or anaesthetics. 63% of patients benefited from MDT involvement during their elective surgical pathway
By the MDT complying with The Centre for Perioperative Care and the British Geriatrics Society guidelines, we have enabled patients living with frailty, listed for urological surgery, to receive:
- Multidisciplinary perioperative risk assessment and optimisation of physiological status
- Patient and family involvement, education and empowerment
- Optimal surgical and anaesthetic management