• Ashwin Subramaniam, Ravindranath Tiruvoipati, Margot Lodge, Christopher Moran, and Velandai Srikanth.
• Department of Intensive Care, Frankston Hospital and The Bays Hospital, Melbourne, Victoria, Australia.
• ANZ J Surg. 2020 Mar 1; 90 (3): 222-229.

BackgroundThe ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post-operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery.MethodsArticles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE.ResultsWe identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened.ConclusionEstablishing multidisciplinary collaborative services to provide person-centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large-scale studies should focus on implementing and evaluating such multicomponent models of care.© 2020 Royal Australasian College of Surgeons.

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