Editorial Views  |   April 2017
Hospital Experience Caring for the Frail: A New Concern for Surgical Patients
Author Notes
  • From the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
  • Accepted for publication January 9, 2017.
    Accepted for publication January 9, 2017.×
  • Corresponding article on page 602.
    Corresponding article on page 602.×
  • Address correspondence to Dr. Wunsch: Hannah.wunsch@sunnybrook.ca
Article Information
Editorial Views / Geriatric Anesthesia
Editorial Views   |   April 2017
Hospital Experience Caring for the Frail: A New Concern for Surgical Patients
Anesthesiology 4 2017, Vol.126, 575-576. doi:10.1097/ALN.0000000000001537
Anesthesiology 4 2017, Vol.126, 575-576. doi:10.1097/ALN.0000000000001537
FOR the management of many medical conditions, such as stroke or myocardial infarction, high-volume centers tend to have better outcomes than low-volume centers.1,2  This appears to be related to experience gained over time and associated services and infrastructure. Such volume–outcome relationships are also well established for surgical procedures, such as cardiac surgery, where a combination of surgical experience and protocolized care pathways are important for optimal outcomes.3  In recent years, frailty—a state of diminished physiologic reserve leading to vulnerability and propensity for adverse outcomes—has become a focus of attention for many patient groups.4  For surgical patients, a state of preoperative frailty has been shown to be an important predictor of postoperative mortality, hospital length of stay, and discharge to long-term care institutions.5,6  These patients may have their own specific care needs after surgery, such as requirements for more aggressive physical therapy, or increased risk of adverse reactions to polypharmacy. If we, therefore, consider frailty as a pathologic state with its own specific care needs, centers that care for a higher volume of frail patients may provide better or more comprehensive care geared for this patient group, leading to better outcomes. In this issue of Anesthesiology, McIsaac et al.7  present the results of a population-level retrospective study, assessing the volume–outcome relationship for frail patients undergoing moderate- to high-risk surgical procedures in Ontario.
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