Preoperative assessment and optimization of cognitive dysfunction and frailty in the ambulatory surgical patient

Preoperative assessment and optimization of cognitive dysfunction and frailty in the ambulatory surgical patient:



Purpose of review

The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the assessment of both cognition and frailty and describe the implementation of these tools in the ambulatory surgery setting.

Recent findings

The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommendations for evaluating at-risk patients focus on a two-pronged approach that encompasses screening for both impaired cognition and frailty. Screening should take place as early as possible but protocols for day-of-surgery assessments, such as the Mini-Cog and the FRAIL Questionnaire are efficient and effective, especially for higher risk patients.

Summary

The recognition of at-risk patients using standardized screening and the use of this assessment to guide perioperative monitoring and treatment is essential for optimizing outcomes for the complex ambulatory surgery patient.

Correspondence to Richard D. Urman, MD, MBA, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, USA. Tel: +1 617 732 8222; e-mail: rurman@bwh.harvard.edu

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