Majority of UK Hospitals Not Screening Older Surgical Patients for Frailty

A recent study conducted by the Royal College of Anesthetists (RCoA) and the University of Nottingham highlights a concerning gap in preoperative care for older adults in the UK. The research reveals that approximately 71% of NHS hospitals are not routinely screening surgical patients aged 60 and above for frailty, despite substantial evidence that frailty significantly influences postoperative outcomes.

Frailty, which affects about 19.6% of surgical patients over 60, involves decreased strength, endurance, and physiological function, leading to increased vulnerability to health complications. Many older individuals with frailty may remain unaware of their condition, which can hinder recovery and increase the risk of adverse events after surgery.

The study, published in the British Journal of Anaesthesia, analyzed data from 7,134 patients across 263 hospitals collected over five days in March 2022. Findings indicate that frail patients tend to stay longer in hospitals—averaging three additional days, and up to six days for severely frail individuals—and face a threefold increase in postoperative complications. They are also four times more likely to develop delirium, a serious confusion state, and have a threefold increased risk of death within a year of surgery.

Assessing frailty using tools like the Clinical Frailty Scale (CFS), where a score of 5 or higher indicates frailty, can enable healthcare providers to tailor treatment plans appropriately. Early identification allows for better preoperative preparation, such as involving geriatricians, discussing realistic recovery expectations, and making informed decisions about surgery.

Despite the simplicity and benefits of screening, the study emphasizes that nearly three-quarters of UK hospitals are not implementing routine frailty assessments. Experts advocate for making frailty screening standard practice for all patients over 60 to improve outcomes and optimize resource use.

Professor Iain Moppett, principal investigator of the study, stressed the importance of collaborative care involving surgeons, anesthetists, and geriatricians to prepare frail patients for surgery. Dr. Claire Shannon, President of the Royal College of Anesthetists, highlighted the potential to significantly improve patient recovery by integrating frailty assessments into routine evaluations.

This research underscores the need for wider adoption of frailty screening in UK hospitals, aiming to enhance patient safety, foster more personalized care, and reduce hospital stays and postoperative complications. Implementing such measures is crucial as the proportion of older surgical patients continues to grow.