Frailty and Sarcopenia in the Colorectal Patient

Frailty and sarcopenia are geriatric conditions, becoming more prevalent with the United Kingdom’s (UK) ageing population. More older patients are presenting for colorectal surgery, who may be frail or sarcopenic. Current literature suggests assessments for these conditions may have a predictive validity for adverse post-operative outcomes. There is confusion as to which measures are of true clinical value.
Qualitative methodologies were employed to determine that whilst surgeons wish for frailty to be routinely identified at St James’ hospital, Leeds, UK, pre-assessment staff would require an intervention to also be available before identification is implemented. Initial pilot studies investigate prevalence of frailty and sarcopenia, identifying that there is a substantial variance between prevalence rates of either condition, depending on the assessment methodology. Initial analyses indicate these measures may not be predictive of post-operative outcomes.
Development of Frailty and Sarcopenia Trial (FAST) identified that whilst prevalence of frailty by different measures varied, predictive validity was poor. FAST also determined that sarcopenia, as measured by the European Working Group of Sarcopenia in Older People criteria, identifies patients who are more likely to require increased care in-hospital, post-operatively. This may support the identification of patients who may fare worse as a result of their operation, and interventions put into place to optimise patient’s clinical conditions pre-operatively.
An eccentric exercise program, lasting 4 weeks, can improve strength in older adults. It is hoped that developments from this study can inform physiotherapy interventions for frail or sarcopenic in-patients in the peri-operative window.
This work highlights the possibility that there may be publication bias regarding frailty and sarcopenia, and that whilst these conditions may be prevalent in a clinical setting, caution is required when considering which assessment should be adopted to be clinically informative in a colorectal surgical pathway.