Peri-operative management of frailty in the orthopedic patient

Pragati H Mamtora; Michelle A Fortier; Sheila R Barnett; Lauren N Schmid; Zeev N Kain

doi:10.1016/j.jor.2020.05.024

Peri-operative management of frailty in the orthopedic patient

J Orthop. 2020 Jun 11:22:304-307. doi: 10.1016/j.jor.2020.05.024. eCollection 2020 Nov-Dec.

Authors

Pragati H Mamtora^{1

2}, Michelle A Fortier^{1

3

4

5}, Sheila R Barnett⁶, Lauren N Schmid¹, Zeev N Kain^{1

3

7

8}

Affiliations

¹ UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA.
² Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
³ Department of Anesthesiology and Perioperative Care, University of California-Irvine, Irvine, CA, USA.
⁴ Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA, USA.
⁵ Department of Pediatric Psychology, Children's Hospital of Orange County, Orange, CA, USA.
⁶ Department of Anesthesiology, Pain Medicine, and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁷ Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA.
⁸ Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.

Abstract

The purpose of this investigation was to summarize current research on diagnosis, outcomes, and management of frail patients undergoing orthopedic surgery. Because frail patients are at increased risk of negative post-operative outcomes including increased 30-day mortality and post-operative complications including infections and delirium, such a review is timely. Strategies including supervised exercise training programs before surgery, early identification of frailty, prophylactic antibiotics, regular drug chart review, regular monitoring of electrolytes, and other strategies to prevent post-operative delirium are helpful in the management of frail orthopedic patients. It is important for surgeons and anesthesiologists to take action in attempt to alleviate adverse post-operative outcomes in frail patients. Ultimately, more research is needed to identify new strategies and to evaluate whether pre-operative optimization can effectively mitigate post-operative outcomes in large-scale randomized controlled trials.

Keywords: Anesthesiology; Frailty; Geriatrics; Orthopedic surgery; Perioperative management.

Publication types

Review