Swarbrick Claire Jane, Williams Karen, Evans Bob, Blake Helen Abigail, Poulton Thomas, Nava Samuel, Shah Akshay, Martin Peter, Louise Partridge Judith Stephanie, Moppett Iain Keith
Anaesthesia, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Centre for Research and Improvement, Royal College of Anaesthetists, London, UK; Anaesthesia a Critical Care, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK.
Centre for Research and Improvement, Royal College of Anaesthetists, London, UK.
Br J Anaesth. 2025 Feb;134(2):328-340. doi: 10.1016/j.bja.2024.11.024. Epub 2025 Jan 6.
Frailty and multimorbidity are common in older adults, but the prevalence and interaction of these conditions in surgical patients remain unclear. This study describes the clinical characteristics of a heterogeneous cohort of older UK surgical patients.
We conducted a prospective observational cohort study during 5 days in March 2022, aiming to recruit all UK patients aged 60 yr and older undergoing surgery, excluding minor procedures (e.g. cataract surgery). Data were collected on patient characteristics, clinical care, frailty, and multimorbidity measures.
A total of 7134 patients from 214 NHS hospitals were recruited, with a mean (sd) age of 72.8 (8.1) yr. Of all operations, 69% (95% confidence interval [CI] 67.9-70.1%) were elective, and 34% (95% CI 32.7-34.8%) were day cases. Of the patients, 19% (95% CI 18.3-20.1%) were living with frailty (Clinical Frailty Score ≥5), and 63.1% (95% CI 62.0-64.3%) were living with multimorbidity (count of ≥2 comorbidities). Those living with frailty, multimorbidity, or both were typically older, were from lower socioeconomic backgrounds, and experienced greater polypharmacy and reduced independence. Patients living with frailty were less likely to undergo elective and day-case surgeries. Four out of five (78.8% [1079/1369]) of those who were living with frailty were also living with multimorbidity; 27.1% (1079/3978) of those who were living with multimorbidity were also living with frailty.
In the UK, one in five older patients undergoing surgery is living with frailty, and almost two-thirds of older patients are living with multimorbidity. These data highlight the importance of frailty screening. In addition, they can serve to guide resource allocation and provide comparative estimates for future research.
衰弱和多种疾病共存现象在老年人中很常见，但这些情况在外科手术患者中的患病率及相互作用仍不明确。本研究描述了英国老年外科手术患者这一异质性队列的临床特征。
我们在2022年3月进行了一项为期5天的前瞻性观察性队列研究，旨在招募所有60岁及以上接受手术的英国患者，不包括小手术（如白内障手术）。收集了患者特征、临床护理、衰弱和多种疾病共存情况的相关数据。
共招募了来自214家国民保健服务（NHS）医院的7134名患者，平均（标准差）年龄为72.8（8.1）岁。在所有手术中，69%（95%置信区间[CI] 67.9 - 70.1%）为择期手术，34%（95% CI 32.7 - 34.8%）为日间手术。在这些患者中，19%（95% CI 18.3 - 20.1%）存在衰弱（临床衰弱评分≥5），63.1%（95% CI 62.0 - 64.3%）存在多种疾病共存（共病数≥2种）。存在衰弱、多种疾病共存或两者皆有的患者通常年龄更大，社会经济背景较低，且用药种类更多，独立性更低。衰弱患者接受择期和日间手术的可能性较小。五分之四（78.8% [1079 / 1369]）的衰弱患者也存在多种疾病共存；27.1%（1079 / 3978）的多种疾病共存患者也存在衰弱。
在英国，五分之一接受手术的老年患者存在衰弱，近三分之二的老年患者存在多种疾病共存。这些数据凸显了衰弱筛查的重要性。此外，它们可用于指导资源分配，并为未来研究提供比较性估计。
