despite the known risks of adverse outcomes, nearly three-quarters of hospitals in the UK are failing to routinely screen older surgical patients for frailty. A study conducted by the royal College of Anaesthetists (RCoA) and the University of Nottingham has revealed that 71% of hospitals do not assess frailty in patients over 60.

The research, published in the British Journal of Anaesthesia, indicates that one in five surgical patients in this age group are living with frailty. This condition elevates the risk of complications, prolongs hospital stays, increases the likelihood of delirium, and raises the risk of death.

Largest UK Study on Frailty in Surgical Patients

The findings originate from the RCoA’s third Sprint National Anaesthesia Project (SNAP3), considered the UK’s most thorough study on frailty and multimorbidity in surgical patients.

Researchers gathered data from 7,129 patients aged over 60 across 214 NHS hospitals over five consecutive days in March 2022.

The observational study revealed that older patients living with frailty experience several negative outcomes:

• Stay an average of 3 days longer in hospital post-surgery
• Stay 6 days longer if they are severely frail
• Are three times more likely to experience complications
• Are four times more likely to develop post-operative delirium
• Are three times more likely to die within a year of surgery

“Identifying frailty is straightforward and should lead to open and honest discussions with patients.”

Lack of Awareness Among Clinicians

The researchers pinpointed limited clinician awareness regarding the impact of frailty and multimorbidity on postoperative outcomes as a significant obstacle to improving patient outcomes.

To address this, the researchers advocate for routine frailty assessments for all patients over 60 prior to surgery. This would facilitate tailored care plans, perhaps involving geriatricians.

The clinical Frailty Scale is presented as a user-amiable assessment tool for clinicians to identify frailty and guide appropriate referrals, according to the RCoA.

Improving Patient Recovery

Dr. Claire Shannon,president of the RCoA,emphasized that global frailty screening has the potential to significantly enhance patient recovery.

“With older people accounting for an increasing proportion of surgical patients, implementing effective screening for frailty is becoming ever more necessary,” she said. “Universal adoption of frailty assessments will not only help patients recover better from surgery but also help improve efficiency by avoiding extended lengths of stay in hospital.”

Iain Moppett, chief investigator of SNAP3 and professor at the University of Nottingham’s School of medicine, highlighted the role of screening in supporting better decision-making.

“Good teamwork between the right specialists – surgeons, anaesthetists, and geriatricians – helps to get patients living with frailty as fit and well as possible before surgery, make the right decisions, and get the best care after surgery,” he said.