Frailty and Surgical Decision Making
Authors: Victoria L. Tang, Kenneth Covinsky
Journal: Annals of Internal Medicine (2016)

Editorials1 November 2016Frailty and Surgical Decision MakingVictoria L. Tang, MD, MAS and Kenneth Covinsky, MD, MPHVictoria L. Tang, MD, MASFrom University of California, San Francisco, San Francisco, California. and Kenneth Covinsky, MD, MPHFrom University of California, San Francisco, San Francisco, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1866 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Frailty is a syndrome of aging that increasingly is being recognized as an important predictor of patient outcomes. The geriatrics literature has conceptualized frailty as a loss of physiologic reserve leading to heightened vulnerability to stressors, such as surgery (1–3). Although the approaches used to measure frailty differ, virtually all seek to capture some element that suggests decreased physiologic reserve (2, 3).After surgery, some older adults quickly return to their presurgical health, whereas others fail to recover at all. As clinicians, we hope to identify frailty in older adults in the preoperative setting to determine which patients are at ...References1. Lipsitz LA. Dynamics of stability: the physiologic basis of functional health and frailty. J Gerontol A Biol Sci Med Sci. 2002;57:B115-25. [PMID: 11867648] CrossrefMedlineGoogle Scholar2. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62:722-7. [PMID: 17634318] CrossrefMedlineGoogle Scholar3. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-56. [PMID: 11253156] CrossrefMedlineGoogle Scholar4. Afilalo J, Kim S, O'Brien S, Brennan JM, Edwards FH, Mack MJ, et al. Gait speed and operative mortality in older adults following cardiac surgery. JAMA Cardiol. 2016;1:314-21. [PMID: 27438112] doi:10.1001/jamacardio.2016.0316 CrossrefMedlineGoogle Scholar5. Alfredsson J, Stebbins A, Brennan JM, Matsouaka R, Afilalo J, Peterson ED, et al. Gait speed predicts 30-day mortality after transcatheter aortic valve replacement: results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation. 2016;133:1351-9. [PMID: 26920495] doi:10.1161/CIRCULATIONAHA.115.020279 CrossrefMedlineGoogle Scholar6. Kim DH, Kim CA, Placide S, Lipsitz LA, Marcantonio ER. Preoperative frailty assessment and outcomes at 6 months or later in older adults undergoing cardiac surgical procedures. A systematic review. Ann Intern Med. 2016;165:650-60. doi:10.7326/M16-0652 LinkGoogle Scholar7. Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med. 2002;346:1061-6. [PMID: 11932474] CrossrefMedlineGoogle Scholar8. Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld CS, Dudley RA. Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc. 2012;60:967-73. [PMID: 22428583] doi:10.1111/j.1532-5415.2012.03915.x CrossrefMedlineGoogle Scholar9. Lilley EJ, Khan KT, Johnston FM, Berlin A, Bader AM, Mosenthal AC, et al. Palliative care interventions for surgical patients: a systematic review. JAMA Surg. 2016;151:172-83. [PMID: 26606747] doi:10.1001/jamasurg.2015.3625 CrossrefMedlineGoogle Scholar10. Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, Grunfeld E, et al. Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc. 2005;53:2184-9. [PMID: 16398907] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, California.Disclosures: Dr. Covinsky reports grants from the National Institutes of Health during the conduct of the study. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1866.Corresponding Author: Victoria L. Tang, MD, MAS, 4150 Clement Street, 181G, San Francisco, CA 94121; e-mail, victoria.[email protected]edu.Current Author Addresses: Dr. Tang: 4150 Clement Street, 181G, San Francisco, CA 94121.Dr. Covinsky: 4150 Clement Street, 111G, San Francisco, CA 94121.This article was published at www.annals.org on 23 August 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPreoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures Dae Hyun Kim , Caroline A. Kim , Sebastian Placide , Lewis A. Lipsitz , and Edward R. Marcantonio Metrics Cited byBarriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic reviewA Systematic Review and Meta-Analysis of Preoperative Frailty Instruments Derived From Electronic Health DataFrailty and long-term postoperative disability trajectories: a prospective multicentre cohort studyAccuracy and Feasibility of Clinically Applied Frailty Instruments before SurgerySurgical decision-making for rectal prolapse: one size does not fit allThe role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective studyRecommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI)Recommendations for preoperative management of frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI)Mortality by Timing of Hip Fracture Surgery 1 November 2016Volume 165, Issue 9Page: 669-670KeywordsCardiac surgeryDisabilitiesElderlyFrailtyLife expectancyMortalityPalliative careQuality of lifeSurgerySystematic reviews ePublished: 23 August 2016 Issue Published: 1 November 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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