Background and Goal of Study:
Frailty is related to post-operative complications. In the United Kingdom (UK), frailty identification is not always part of the surgical pathway. This study investigates the perspectives and experiences of surgeons, general practitioners (GPs) and surgical assessment staff about identifying and managing frailty and explore the feasibility of implementing frailty identification at surgical pre-assessment.
Materials and Methods:
Surgeons and GPs were invited to individual interviews, and surgical pre-assessment staff to a focus group. Population-specific, open-ended, semi-structured topic guides were designed. Surgeons were asked how knowing about frailty might change surgical planning. GPs were asked how frailty should be identified and treated in surgical patients. Pre-assessment staff were asked who should be identifying frailty in surgical patients, and the barriers of implementation. Thematic analysis was used to examine the data, allowing interpretation within and across populations. Ethical approval was granted (15/YH/0513).
Results and Discussion:
5 consultant general surgeons were interviewed. All agreed identification of frailty is vital to ensure the correct post-operative care package is in place. Patients with frailty were expected to have a longer, less predictable recovery. Surgeons felt responsible for both identification and treatment of frailty in their patients. With reliable identification, current systems can support the additional care needs.
4 GPs were interviewed; all agreed frailty is becoming more prevalent. GPs interviewed identify frailty using an electronic frailty index though report limited clinical value. GPs may assess frailty before making a surgical referral, but do not consider it part of their role to assess fitness for surgery based on these scores.
Surgical pre-assessment staff at the focus group disagreed on the clinic’s purpose; either to assess fitness for anaesthesia, or support discharge planning by referring to services that optimise patients prior to surgery. The staff agreed that frailty should be identified in their clinic. Adoption of frailty assessments should require minimal paperwork and utilise rapid clinical judgement.
Conclusion(s):
Frailty identification is missing from Leeds hospitals’ surgical assessments, yet all groups support its implementation. Whilst GPs can identify frailty, all populations felt management should come from surgeons and surgical staff.

08 / FAST (Frailty And Sarcopenia Trials): A qualitative investigation into frailty identification implementation into the general surgical pathway, in the UK.