UK Hospitals Missing Frailty Screening for Surgery Patients

Nearly three-quarters of UK hospitals are not routinely screening older surgical patients for frailty, despite known risks of adverse outcomes.

A study by the Royal College of Anaesthetists (RCoA) and the University of Nottingham found that 71% of hospitals do not assess frailty in patients over 60.

The research, published in the British Journal of Anaesthesia, shows that 1 in 5 surgical patients in this age group are living with frailty. This condition significantly increases the risk of complications, extended hospital stays, delirium, and death.

Largest UK Study on Frailty in Surgical Patients

The findings are from the RCoA’s third Sprint National Anaesthesia Project (SNAP3), the UK’s most comprehensive study on frailty and multimorbidity in surgical patients. 

Researchers collected data from 7129 patients aged over 60 across 214 NHS hospitals. Data was gathered over 5 consecutive days in March 2022. 

The observational study found that older patients living with frailty: 

• Stay an average of 3 days longer in hospital post-surgery
• Stay 6 days longer if they are severely frail
• Are three times more likely to experience complications
• Are four times more likely to develop post-operative delirium
• Are three times more likely to die within a year of surgery

Lack of Awareness Among Clinicians

The researchers identified limited clinician awareness about the impact of frailty and multimorbidity on postoperative outcomes as a key barrier to improving outcomes.

The researchers recommended routine frailty assessments for all patients over 60 before surgery. This would allow for tailored care, with input from geriatricians where appropriate.

The Clinical Frailty Scale is a simple assessment tool that clinicians can use to identify frailty and guide appropriate referrals, the RCoA said. 

Improving Patient Recovery

Dr Claire Shannon, president of the RCoA, said universal frailty screening could significantly improve patient recovery. 

“With older people accounting for an increasing proportion of surgical patients, implementing effective screening for frailty is becoming ever more necessary,” she said. “Universal adoption of frailty assessments will not only help patients recover better from surgery but also help improve efficiency by avoiding extended lengths of stay in hospital.”

Iain Moppett, chief investigator of SNAP3 and professor at the University of Nottingham’s School of Medicine, said screening supports better decision-making.

“Identifying frailty is straightforward and should lead to open and honest discussions with patients,” he said. “Good teamwork between the right specialists — surgeons, anaesthetists, and geriatricians — helps to get patients living with frailty as fit and well as possible before surgery, make the right decisions, and get the best care after surgery.”

Priscilla Lynch is a freelance writer for Medscape with over 20 years’ experience covering medicine and healthcare. She has a Master’s degree in journalism and recently undertook a Health Innovation Journalism Fellowship with the International Center for Journalists.