Perioperative medicine & outcomes
Peri‐operative cardiac arrest in the older frail patient as reported to the 7th National Audit Project of the Royal College of Anaesthetists
Authors' conclusion
We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri-operative cardiac arrest compared with patients of the same age not living with frailty.
Study context
- Population
- Patients aged > 65 y undergoing anaesthesia and surgery, and those reported to the peri-operative cardiac arrest case registryactivity survey, aged > 65 y
- Participants
- 6,466 patients
- Exposure
- Older patients living with frailty vs not frail
- Outcome
- Frailty prevalence and peri-operative cardiac arrest in older frail patients
Methodological detailsactivity survey, peri-operative cardiac arrest case registry
- Activity survey
- Peri-operative cardiac arrest case registry
Main finding
As reported in the abstract
Frail (Clinical Frailty Scale score ≥ 5) in activity survey, aged > 65 y
1676 (26%) of 6466
Cardiac arrests in patients aged > 65 y living with frailty
156 (18%) of 881
Estimated incidence of cardiac arrest in older frail patients
1 in 1204
95%CI 1 in 1027–1412
Mortality rate in older frail patients (95%CI 1 in 1642-2488); ≈2.6-fold higher than in adults who were not frail
1 in 2020
Observational data: associations, not effects.
Further findings
Comorbidities and emergency surgery
- Increasing age and frailty both associated with increasing comorbidities and proportion of emergency surgery
Complex or major surgery
- Increasing frailty associated with increased proportion of complex or major surgery, except in terminally ill (Clinical Frailty Scale score 9)
Invasive arterial BP monitoring
- Use associated with frailty only until Clinical Frailty Scale score 5, then plateaued or fell
Surgical procedures in older frail patients with cardiac arrest
- Most common: hip fracture, emergency laparotomy, emergency vascular surgery, urological surgery
Original publication
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