Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey
Abstract Background Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current periope...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-022-00471-7 |
| _version_ | 1828056929350451200 |
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| author | Mallaika Viswanath Darja Clinch Marco Ceresoli Jugdeep Dhesi Mario D’Oria Belinda De Simone Mauro Podda Salomone Di Saverio Federico Coccolini Massimo Sartelli Fausto Catena Ernest Moore Deepa Rangar Walter L. Biffl Dimitrios Damaskos |
| author_facet | Mallaika Viswanath Darja Clinch Marco Ceresoli Jugdeep Dhesi Mario D’Oria Belinda De Simone Mauro Podda Salomone Di Saverio Federico Coccolini Massimo Sartelli Fausto Catena Ernest Moore Deepa Rangar Walter L. Biffl Dimitrios Damaskos |
| author_sort | Mallaika Viswanath |
| collection | DOAJ |
| description | Abstract Background Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons’ awareness and perception of perioperative frailty management, and barriers to its implementation. Methods A qualitative cross-sectional survey was sent via the World Society of Emergency Surgery e-letter to their members. Responses were analysed using descriptive statistics and reported by themes: risk scoring systems, frailty awareness and assessment and barriers to implementation. Result Of 168/1000 respondents, 38% were aware of the terms “Perioperative medicine for older people undergoing surgery” (POPS) and Comprehensive Geriatric Assessment (CGA). 66.6% of respondents assessed perioperative risk, with 45.2% using the American Society of Anaesthesiologists Physical Status Classification System (ASA-PS). 77.8% of respondents mostly agreed or agreed with the statement that they routinely conducted medical comorbidity management, and pain and falls risk assessment during emergency surgical admissions. Although 98.2% of respondents agreed that frailty was important, only 2.4% performed CGA and 1.2% used a specific frailty screening tool. Clinical frailty score was the most commonly used tool by those who did. Screening was usually conducted by surgical trainees. Key barriers included a lack of knowledge about frailty assessment, a lack of clarity on who should be responsible for frailty screening, and a lack of trained staff. Conclusions Our study highlights the ubiquitous lack of awareness regarding frailty assessment and the POPS model of care. More training and clear guidelines on frailty scoring, alongside support by multidisciplinary teams, may reduce the burden on surgical trainees, potentially improving rates of appropriate frailty assessment and management of the frailty syndrome in emergency surgical patients. |
| first_indexed | 2024-04-10T21:04:17Z |
| format | Article |
| id | doaj.art-6c5694f59411474087dca545c35bf5db |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-10T21:04:17Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-6c5694f59411474087dca545c35bf5db2023-01-22T12:07:44ZengBMCWorld Journal of Emergency Surgery1749-79222023-01-0118111110.1186/s13017-022-00471-7Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative surveyMallaika Viswanath0Darja Clinch1Marco Ceresoli2Jugdeep Dhesi3Mario D’Oria4Belinda De Simone5Mauro Podda6Salomone Di Saverio7Federico Coccolini8Massimo Sartelli9Fausto Catena10Ernest Moore11Deepa Rangar12Walter L. Biffl13Dimitrios Damaskos14University of EdinburghRegistrar in General Surgery, Royal Infirmary of EdinburghGeneral and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca UniversityDepartment of Ageing and Health, Guy’s and St Thomas NHS Foundation TrustDivision of Vascular and Endovascular Surgery, Cardiovascular Departments, University Hospital of Trieste, ASUGIUnit of Digestive and Bariatric Surgery, Clinique Saint LouisEmergency Surgery Unit, Department of Surgical Science, University of CagliariHospital of San Benedetto del TrontoEmergency and Trauma Surgery Department, Pisa University HospitalDepartment of Surgery, Macerata HospitalGeneral and Emergency Surgery Dept, Bufalini HospitalDenver Health System-Denver Health Medical CenterMedicine of the Elderly, Royal Infirmary of EdinburghScripps Memorial Hospital La JollaDepartment of General Surgery, Royal Infirmary of EdinburghAbstract Background Frailty is associated with poor post-operative outcomes in emergency surgical patients. Shared multidisciplinary models have been developed to provide a holistic, reactive model of care to improve outcomes for older people living with frailty. We aimed to describe current perioperative practices, and surgeons’ awareness and perception of perioperative frailty management, and barriers to its implementation. Methods A qualitative cross-sectional survey was sent via the World Society of Emergency Surgery e-letter to their members. Responses were analysed using descriptive statistics and reported by themes: risk scoring systems, frailty awareness and assessment and barriers to implementation. Result Of 168/1000 respondents, 38% were aware of the terms “Perioperative medicine for older people undergoing surgery” (POPS) and Comprehensive Geriatric Assessment (CGA). 66.6% of respondents assessed perioperative risk, with 45.2% using the American Society of Anaesthesiologists Physical Status Classification System (ASA-PS). 77.8% of respondents mostly agreed or agreed with the statement that they routinely conducted medical comorbidity management, and pain and falls risk assessment during emergency surgical admissions. Although 98.2% of respondents agreed that frailty was important, only 2.4% performed CGA and 1.2% used a specific frailty screening tool. Clinical frailty score was the most commonly used tool by those who did. Screening was usually conducted by surgical trainees. Key barriers included a lack of knowledge about frailty assessment, a lack of clarity on who should be responsible for frailty screening, and a lack of trained staff. Conclusions Our study highlights the ubiquitous lack of awareness regarding frailty assessment and the POPS model of care. More training and clear guidelines on frailty scoring, alongside support by multidisciplinary teams, may reduce the burden on surgical trainees, potentially improving rates of appropriate frailty assessment and management of the frailty syndrome in emergency surgical patients.https://doi.org/10.1186/s13017-022-00471-7FrailtyEmergency surgeryComprehensive geriatric assessmentClinical frailty score |
| spellingShingle | Mallaika Viswanath Darja Clinch Marco Ceresoli Jugdeep Dhesi Mario D’Oria Belinda De Simone Mauro Podda Salomone Di Saverio Federico Coccolini Massimo Sartelli Fausto Catena Ernest Moore Deepa Rangar Walter L. Biffl Dimitrios Damaskos Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey World Journal of Emergency Surgery Frailty Emergency surgery Comprehensive geriatric assessment Clinical frailty score |
| title | Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey |
| title_full | Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey |
| title_fullStr | Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey |
| title_full_unstemmed | Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey |
| title_short | Perceptions and practices surrounding the perioperative management of frail emergency surgery patients: a WSES-endorsed cross-sectional qualitative survey |
| title_sort | perceptions and practices surrounding the perioperative management of frail emergency surgery patients a wses endorsed cross sectional qualitative survey |
| topic | Frailty Emergency surgery Comprehensive geriatric assessment Clinical frailty score |
| url | https://doi.org/10.1186/s13017-022-00471-7 |
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