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Review
. 2020 Nov 9;28(3):332-336.
doi: 10.1097/GME.0000000000001681.

The impact of frailty in older women undergoing pelvic floor reconstructive surgery

Jonathan S Shaw  1 , Elisabeth Erekson  2 , Holly E Richter  3
Affiliations
Review

The impact of frailty in older women undergoing pelvic floor reconstructive surgery

Jonathan S Shaw et al. Menopause. .

Abstract

Importance and objective: Women ≥ 65 years old commonly undergo pelvic surgery but are often not screened for coexisting frailty, the presence of which increases the risk of postoperative complications. In the absence of a current consensus, the objective of this review is to discuss the incorporation of a frailty assessment into the work-up of women undergoing pelvic floor reconstructive surgery.

Methods: This is a review of the literature, focusing on measurements of frailty including the Edmonton Frail Scale, FRAIL scale, Groningen Frailty Indicator, frailty phenotype, Tilburg Frailty Indicator, a 70-item frailty index, Mini-Cog score, Charlson comorbidity index, timed up and go test, and life-space assessment. Their use in the perioperative management of older women undergoing pelvic floor reconstructive surgery will be discussed.

Discussion and conclusion: Understanding the concept of frailty and how it may affect surgical decisions and outcomes is essential. The timed up and go test, life space assessment and Mini-Cog assessment at a minimum should be considered preoperatively in patients over the age of 65 years old planning pelvic floor or elective surgery.

Plain language summary

Video Summary:http://links.lww.com/MENO/A676.

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Conflict of interest statement

Financial disclosure/conflicts of interest: Holly E. Richter - Grant funding: NICHD, NIA, Renovia, Allergan; Royalties: Up to Date; Board Member: World Wide Fistula Fund; Editor reimbursement: Obstetrics & Gynecology, Intl Urogyn J; DSMB Blue Wind Medical. The other authors have nothing to disclose.

References

    1. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 210:901–908.
    1. Washington DC, Centers for Disease Control and Prevention. National Hospital Discharge Survey. 2010.
    1. Erekson EA, Ratner ES, Walke LM, Fried TR. Gynecologic surgery in the geriatric patient. Obstet Gynecol 2012; 119:1262–1269.
    1. Kim S, Han H-S, Jung H, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg 2014; 149:633–640.
    1. Sternberg SA, Schwartz AW, Karunananthan S, Bergman H, Mark Clarfield A. The identification of frailty: a systematic literature review. J Am Geriatr Soc 2011; 59:2129–2138.

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