​Experience matters when it comes to caring for frail surgical patients, say the authors of a study published in the April 2017 issue of Anesthesiology. The authors conducted a retrospective, population-based cohort study on data from 63,381 frail patients undergoing elective, noncardiac surgery at one of 81 Canadian hospitals between April 1, 2002, and March 31, 2014. In total, 708 (1.1%) of the studied patients died within 30 days of surgery. The 30-day mortality rate at the hospitals that dealt with the lowest volume of frail patients was 1.1%, compared with 0.9% at hospitals that dealt most often with frail patients. While this may not be a significant difference, the authors found a "significant association between frailty volume and improved survival after adjusting for surgical risk, demographics, comorbidities, and clustering within hospitals." The findings also showed an increased risk of failure-to-resuscitate events compared with frail patients at hospitals that operate on higher volumes of frail patients occurring at hospitals that treat low volumes of frail patients. "These findings suggest that improving the outcomes of patients undergoing major surgery may be accomplished not only through a focus on centers performing higher volumes of specific surgeries but also through a focus on avoiding low-volume centers in regard to the number of frail patients cared for," the authors said. An accompanying editorial said that frailty should be considered a "pathologic state with its own specific care needs." The issue also included an infographic explaining why experience treating frail surgical patients is so important. According to the infographic, challenges of caring for frail patients include the presence of complex conditions and uncertain care planning.

HRC Recommends: Risk managers should support their surgical departments in addressing risk management issues that may arise with older patients. Risk managers should work closely with their quality improvement departments to monitor the quality of care provided to older surgical patients. An organization may want to provide geriatric consultative services to assist clinicians in addressing the special needs of the older patient. Specifically, risk managers should identify and address risk management issues involving older patients; provide education for clinicians on the special needs of these patients; ascertain upon admission whether a patient has executed or wishes to execute an advance directive; and require medical record documentation of discussions held with the patient or surrogate and family about end-of-life decision-making.