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THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals.

FRAILTY AND THE PREOPERATIVE ASSESSMENT Thomas Robinson, MD Associate Professor, Surgery University of Colorado August 5th, 2009. AGS. THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults. Traditional PreOperative Evaluation.

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THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals.

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  1. FRAILTY AND THE PREOPERATIVE ASSESSMENTThomas Robinson, MDAssociate Professor, SurgeryUniversity of ColoradoAugust 5th, 2009 AGS THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults.

  2. Traditional PreOperative Evaluation Single end-organ function assessment does not capture all the information required to predict adverse outcomes for the geriatric patient

  3. DEFINITION OF FRAILTY • Frailty is an excess vulnerability to stressors, with reduced ability to maintain or regain homeostasis after a destabilizing event • A non-specific state of increasing risk… measured by the accumulation of frailty traits JAGS. (2006) 54:991. JAGS. (2007) 7:722.

  4. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  5. Accumulation of Frailty Characteristics FRAILTY AVERAGE OUTCOMES POOR OUTCOMES

  6. Accumulation of Frailty Characteristics FRAILTY Functional Impairment Normal Mood AVERAGE OUTCOMES POOR OUTCOMES

  7. Accumulation of Frailty Characteristics No Geriatric Syndromes Impaired Cognition FRAILTY Normal Mood Functional Impairment AVERAGE OUTCOMES POOR OUTCOMES

  8. Accumulation of Frailty Characteristics Normal Albumin Low Burden of Chronic Disease Impaired Cognition FRAILTY No Geriatric Syndromes Functional Impairment Normal Mood AVERAGE OUTCOMES POOR OUTCOMES

  9. Accumulation of Frailty Characteristics Low Albumin High Burden of Chronic Disease No Geriatric Syndromes FRAILTY Impaired Cognition Normal Mood Functional Impairment AVERAGE OUTCOMES POOR OUTCOMES

  10. Frailty and PostOperative Complications Long-Term OPERATION Hospital Course

  11. Frailty and PostOperative Complications Long-Term OPERATION Hospital Course • Patients age ≥ 70 years undergoing inpatient operations (n = 125) underwent baseline frailty assessment • Increased frailty score was associated with: • Increased post-op complications (P = .02) • Longer hospital stay (P < .01) Arch Gerontol Geriatr (2009) 48:78. Crit Rev Onc/Heme. (2009) epub.

  12. Frailty and PostOperative Complications Long-Term OPERATION Hospital Course • Patients age ≥ 65 years undergoing inpatient operations (n = 110) underwent baseline frailty assessment • Four or more frailty markers predicted 6-month mortality: • Sensitivity 81% • Specificity 86% Ann Surg. (2009) 250:449.

  13. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  14. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  15. Frailty Characteristic: Function JACS. (2010) 210:503.

  16. Frailty Characteristic: Function JACS. (2010) 210:503.

  17. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  18. FrailtyCharacteristic:Hypoalbuminemia • Lower albumin is related to increased thirty-day morbidity and mortality across multiple surgical specialties in a dose response fashion. • Low serum albumin level was found to be most closely related to 30-day post-operative mortality from more than 30 pre-operative variables. Arch Surg. (1999) 134:36. J Am Coll Surg. (1997) 185:315.

  19. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  20. Frailty Characteristic:Geriatric Syndromes • ASA score of III or IV is closely related to 1-year mortality following hip fracture(P < .001) • Pre-existing burden of chronic disease predicts 1-year mortality following hip fracture J Bone Joint Surg. (1995) 77:1551. J Bone Min Res. (2005) 20:494.

  21. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  22. Frailty Characteristic: Cognition Dan Wu, Tom Robinson. American College of Surgeon’s Surgical Forum (2010).

  23. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  24. Frailty Characteristic: Mood Ann Thor Surg. (2005) 79:1255.

  25. Frailty Characteristics Functional Impairment Functional Impairment Geriatric Syndromes Low Albumin Geriatric Syndromes Low Albumin FRAILTY Depressed Mood Burden of Chronic Disease Depressed Mood Burden Chronic Disease Impaired Cognition Impaired Cognition

  26. Frailty Characteristic:Geriatric Syndromes Ann Surg. (2009) 250:449.

  27. Accumulation of Frailty Characteristics Low Albumin High Burden of Chronic Disease No Geriatric Syndromes FRAILTY Impaired Cognition Normal Mood Functional Impairment AVERAGE OUTCOMES POOR OUTCOMES

  28. THANK YOU FOR YOUR TIME! Visit us at: www.americangeriatrics.org Facebook.com/AmericanGeriatricsSociety Twitter.com/AmerGeriatrics linkedin.com/company/american-geriatrics-society

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