Frailty in emergency general surgery and the role of the perioperative physician/geriatrician

The aging of the population is a fact, and with it, our surgical patients are becoming increasingly more complex and frailer. It is a well-known aspect of our practice nowadays, but its impact was not recognized until recently. The article by Pearse et al.¹ showed us that mortality in major abdominal/colonic procedures in patients over 69 years of age is significant, perhaps more than we wanted to believe. The issues around the need for better care for elderly patients undergoing emergency surgery were subsequently identified in the Peri-operative Care: Knowing the Risk NCEPOD document (2011).² In that report, the role of frailty has been highlighted by the authors and particular attention was given to multiple comorbidities/polypharmacy/cognitive and sensory impairment compromising the outcomes of these patients. The subsequent (2015) National Emergency Laparotomy Audit report³ issued specific recommendations that patients over 70 undergoing an emergency laparotomy should have Input from specialist Care of the Elderly teams. [...]