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SNAP3: One in five older surgical patients living with frailty (Clinical Frailty Scale ≥ 5). Around half with multiple long-term conditions. British Geriatrics Society SNAPs News Centre for Perioperative Care RCoA Centre for Research & Improvement Age UK 10/

SNAP3: Frailty - I suspect these images are stereotypical for many anaesthetists – frailty equated with a) being in a hospital bed b) ‘looking frail’ c) being female c) having a hip fracture. But that’s certainly not the whole story RCoA Centre for Research & Improvement SNAPs News 11/

SNAP3: Frailty – common in men; occurs in overweight and underweight; associated with area level deprivation (index of multiple deprivation). Should we factor in someone’s area of residence into risk assessment? British Geriatrics Society RCoA Centre for Research & Improvement Centre for Perioperative Care SNAPs News 12/

SNAP3: Apologies to the geriatricians who already know this… but frailty and multimorbidity aren’t the same thing. Most people who are living with frailty have multiple long-term conditions, but the reverse isn’t true. British Geriatrics Society SNAPs News Age UK 13/

SNAP3: People living with frailty stay in hospital longer. No surprise? But look where the difference starts. CFS-4 (aka ‘vulnerable’ or ‘mild frailty’) – not the totemic CFS-5. I’m pretty certain ‘refer geriatrics’ isn’t the answer. British Geriatrics Society Centre for Perioperative Care SNAPs News RCoA Centre for Research & Improvement 15/

SNAP3: Delirium - confounding of course, but delirium in the surgical patient is associated with longer lengths of stay. SNAPs News RCoA Centre for Research & Improvement Alasdair MacLullich European Delirium 16/

SNAP3: Time to test yourselves (no peeking at the next post). Which of these do you think represents the proportion of older surgical patients developing delirium? European Delirium British Geriatrics Society RCoA Centre for Research & Improvement 17/

SNAP3: Who gets delirium? Increasing frailty is a big risk. But look carefully – the risk increases with CFS-4. Current guidance is all based on CFS-5… European Delirium Alasdair MacLullich British Geriatrics Society SNAPs News RCoA Centre for Research & Improvement 19/

SNAP3: Frailty associated with increased risk of postoperative mortality, even when other things are taken into account. Again – CFS-4 making a bid to be counted seriously… SNAPs News Centre for Perioperative Care British Geriatrics Society 20/

SNAP3: But it’s ok. UK perioperative services (in 2022) were set-up to identify all these high risk folk. Right? Routine frailty screening in only 1 in 4 hospitals. I’d like to think this has improved… Centre for Perioperative Care RCoA Centre for Research & Improvement British Geriatrics Society SNAPs News 21/

SNAP3: Nurse-led preop is the commonest for the older surgical patient. Are the right patients being directed to anaesthetist clinics? Geriatrician-led MDT clinics appear to be rare. British Geriatrics Society RCoA Centre for Research & Improvement SNAPs News The Royal College of Surgeons of Edinburgh The Royal College of Surgeons of England 22/

SNAP3: Does it matter how frailty screening is done? Yes – it needs to be done properly - it's not an 'end-of-the-bed-o-gram'. Perhaps no – the tool may not matter so much. Good agreement between CFS and Edmonton scales. British Geriatrics Society RCoA Centre for Research & Improvement Centre for Perioperative Care The Royal College of Surgeons of England The Royal College of Surgeons of Edinburgh 23/

SNAP3: Cognitive screening not routine either (in 2022 – maybe it’s improved?) Bit of a mish-mash of tools used. Would be interesting to hear from geriatricians for the best screening tools to use at scale. Centre for Perioperative Care British Geriatrics Society RCoA Centre for Research & Improvement SNAPs News 24/

Centre for Perioperative Care British Geriatrics Society RCoA Centre for Research & Improvement SNAPs News SNAP3: Post-operative delirium assessment. 4AT in the lead but not universal. Shouldn’t we just settle on 4AT? Widely validated, easy to use – what’s not to like Alasdair MacLullich European Delirium RCoA Centre for Research & Improvement British Geriatrics Society 25/

SNAP3: Let’s not forget our medical registrar colleagues. Maybe if we managed frailty and delirium better we could lessen their workload. Looks like they have orthopaedics, colorectal and upper GI on speed dial. British Geriatrics Society Centre for Perioperative Care SNAPs News The Royal College of Surgeons of England The Royal College of Surgeons of Edinburgh 26/

SNAP3: Why do medical registrars see older surgical patients? Arrhythmia, respiratory and electrolytes. How much of this is avoidable through better pre-op planning and / or periop protocols? British Geriatrics Society Centre for Perioperative Care RCoA Centre for Research & Improvement SNAPs News 26/

SNAP3: Reality on the ground for provision of perioperative services for older people someway off the vision (a good one) of organisations like Centre for Perioperative Care Some easy wins to get us closer? Systematic frailty and delirium screening; local guidelines? British Geriatrics Society Royal College of Anaesthetists 27/

SNAP3: Key messages. Older surgical patients: 20% living with frailty; outcomes (length of stay, delirium, mortality) all worse with frailty - starting at CFS4; service organisation has room for improvement. Centre for Perioperative Care British Geriatrics Society The Royal College of Surgeons of Edinburgh The Royal College of Surgeons of England SNAPs News 28/

SNAP3: Finally huge thanks to Claire Swarbrick for making SNAP3 a reality; Jude Partridge my amazing co-I; the team RCoA Centre for Research & Improvement SNAPs News; Bob and Carol our amazing PPI; the Frances and Augustus Newman Foundation for support; Uni of Nottingham School of Medicine #WeAreUoN 29/

Great to see Claire Swarbrick presenting on #SNAP3 on Day 2 of the Winter Symposium. Results show the significant impact that living with frailty has on postoperative outcomes, reinforcing the need for universal frailty screening in older patients. #RCoAWinter SNAPs News Royal College of Anaesthetists