Prevalence of frailty in surgical older patients and its impact on assisted discharge

Background & aim. An increasing number of older persons is today undergoing emergency and elective surgical procedures. Frailty is a highly prevalent condition and a predictor of postoperative adverse outcomes. This study is aimed at measuring the prevalence of frailty among older persons awaiting for surgical procedures, and the activation of services supporting protected discharge from the hospital in individuals with high vulnerability to stressors. Methods. A prospective observational study was conducted in patients aged 65 years and older waiting for surgery. Frailty was measured using the criteria proposed by Robinson and colleagues. Length of stay and care services activated at the discharge recorded. Results. A total of 1,144 patients were recruited. Two-hundred and seventeen (19%) patients were defined as frail, and 395 (34.5%) were pre-frail. The average length of post-operative stay was 5 days. Only 39 (3.4%) patients received care plan assuring a protected discharge. Among these, 35 (89.7%) were frail, 4 (10.3%) pre-frail. The variable most strongly correlated with the activation of services supporting an assisted discharge was the dependence in activities of daily living (ρ = 0.27, p < 0.001). Conclusions. Frailty is a highly prevalent condition among persons undergoing emergency and elected surgery procedures. Nevertheless, services supporting assisted discharge on the territory are quite infrequently activated. An improved integration of care services bridging hospital and community is necessary and therefore a lack of continuity of health and social care. Further research should focus on the postoperative management of the frail elderly patient.