Introduction: With the ageing population in the United Kingdom, more elderly patients are undergoing surgery with the incidence of frailty and multi-morbidity increasing.
Aims: Describe interventions prompted by the comprehensive geriatric assessment(CGA) in the prehabilitation setting amongst elective thoracic surgical patients, investigate associations between pre-operative frailty score and post-operative complications, determine if pre-operative assessment is predictive of post-operative complications and the prevalence of frailty in this cohort.
Method: A retrospective cohort review of electronic medical records of 105 consecutive patients between October 2022 and August 2023 who underwent a CGA and prehabilitation prior to undergoing elective thoracic surgery, was conducted at a single centre tertiary referral hospital. Demographic information, interventions prompted by the CGA, Montreal Cognitive assessment (MoCA) and post-operative complications were recorded. Frailty was measured using the Clinical Frailty Score (CFS) and Edmonton Frailty Score (EFS). Descriptive statistics and Chi-squared analysis were performed to assess the aims.
Results: The mean age=74.1 years, CFS=3.55 and EFS=4.24. Of 95(90.5%) patients who proceeded to surgery, 12 (12.6%)(CFS≥5) and 29 (30.8%)(EFS≥6) were frail. Post-operative complications occurred in 49 (51.6%) of patients and there was a statistically significant association, between frailty (CFS≥5) and likelihood of post-operative complications χ2(1)=4.779, p=0.03. New cognitive impairment was diagnosed in 18.1%(n=19), of whom 89.5%(n=17) had mild cognitive impairment (MCI). Medication changes were recommended in 71.4%(n=75), of which 49.3%(n=37) cardio-pulmonary medication changes. 34.7% of the post-operative medical complications were anticipated pre-operatively.
Conclusion: In this elective thoracic surgical population, CGA identified cognitive impairment, frailty and was able to anticipate post-operative complications.