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Frailty in the peri-surgical context 

Frailty in the peri-surgical context
Frailty in the peri-surgical context

Peter Crome

and Frank Lally

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date: 12 July 2020

This chapter reviews the relatively new concept of frailty and its importance to surgery and anaesthesia. It begins by exploring the definitions of frailty and risk this poses to elderly surgical patients. Models of frailty are reviewed, including those of Fried and Rockwood and combinations of the two, against their value in predicting risk. After discussing the epidemiology of frailty, the chapter discusses the assessment of frailty in surgical patients and the outcomes. The data presented suggests that frailty does lead to poorer outcomes. The link between immunosenescence and frailty is then explored with biomarkers of inflammation such as C-reactive protein, interleukin-6 and tumour necrosis factor-α present in many aged patients. The possibility of managing or treating frailty before surgery is then reviewed, but while there is no evidence that the use of anti-inflammatory drugs have benefits, there is more possibility with exercise and anabolic approaches.

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