Preoperative Frailty Assessment: A Tool to Empower Patient Choice and Improve Surgical Decision making

Grant Application

Patrick R. Varley, MD, UPMC Presbyterian, in collaboration with Daniel E. Hall, MD, MDiv, MHSc, UPMC Presbyterian and theCenter of Bioethics and Health Law, University of Pittsburgh

Proposed Innovation

Patients who undergo major surgery are at risk for complications; understanding the likely benefits and burdens of proposed surgery is a critical component of the medical decision making process for both patients and providers. Frailty is a well-recognized clinical syndrome marked by significantly reduced physiologic reserve that places patients at risk for adverse outcomes following surgery. In fact, recent data suggests that frailty is a better predictor of perioperative morbidity, mortality, and cost than age and/or other existing medical conditions alone.

The goal of this project is to design and implement a frailty screening tool for UPMC patients before they undergo elective surgical procedures in order to identify the patients at greatest risk for poor outcomes — and specify the likelihood of those risks —before making the decision to operate. Identifying frail patients prior to surgery will empower patients and providers to better align surgical decisions with patient preferences and values.

 

Improvements in Action

By developing a simple yet effective tool to identify the patients at greatest risk for poor outcomes following surgery, UPMC will be able to deploy additional resources to improve the perioperative care of frail patients. This could include preoperative, interdisciplinary consultation with a variety of experts to advise patients about the procedure and, if surgery is chosen, optimize outcomes though preoperative nutrition and strength training, intraoperative management tailored to the needs of the frail, and postoperative care attuned to the most likely complications.

 

Results – In Progress

Information gathered from the analysis and evaluation will be published and disseminated to providers within and outside the UPMC system. Ideas generated from the project will be used in the development of future decision support tools. As of July 1, 2015, two research papers have been developed on the use of pathways, where significant increases in the number of minimally invasive procedures have been demonstrated since 2012.