SummaryFrailty increases peri‐operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri‐operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of Anaesthetists, we described the characteristics of older patients living with frailty undergoing anaesthesia and surgery, and those reported to the peri‐operative cardiac arrest case registry. In the activity survey, 1676 (26%) of 6466 patients aged > 65 y were reported as frail (Clinical Frailty Scale score ≥ 5). Increasing age and frailty were both associated with increasing comorbidities and the proportion of surgery undertaken as an emergency. Except in patients who were terminally ill (Clinical Frailty Scale score 9), increasing frailty was associated with an increased proportion of complex or major surgery. The rate of use of invasive arterial blood pressure monitoring was associated with frailty only until Clinical Frailty Scale score 5, and then plateaued or fell. Of 881 cardiac arrests reported to the 7th National Audit Project, 156 (18%) were in patients aged > 65 y and living with frailty, with an estimated incidence of 1 in 1204 (95%CI 1 in 1027–1412) and a mortality rate of 1 in 2020 (95%CI 1 in 1642–2488), approximately 2.6‐fold higher than in adults who were not frail. Hip fracture, emergency laparotomy, emergency vascular surgery and urological surgery were the most common surgical procedures in older patients living with frailty who had a cardiac arrest. We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri‐operative cardiac arrest compared with patients of the same age not living with frailty.

中文翻译：

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皇家麻醉师学院第七次国家审计项目报告老年体弱患者围术期心脏骤停

摘要虚弱会增加围手术期风险，但缺乏其负担、临床特征以及围手术期心脏骤停的风险和结果的详细信息。作为对皇家麻醉师学院第七次国家审计项目的预先计划分析，我们描述了接受麻醉和手术的老年体弱患者的特征，以及向围手术期心脏骤停病例登记处报告的特征。在活动调查中，6466 名年龄 > 65 岁的患者中，有 1676 名（26%）被报告为虚弱（临床虚弱量表评分≥ 5）。年龄的增长和身体虚弱都与合并症的增加以及急诊手术比例的增加有关。除绝症患者（临床衰弱量表评分为 9）外，衰弱程度的增加与复杂或大型手术比例的增加有关。有创动脉血压监测的使用率仅在临床衰弱量表评分为 5 分之前与衰弱相关，然后趋于稳定或下降。在第七次国家审计项目报告的 881 例心脏骤停中，有 156 例 (18%) 患者年龄 > 65 岁且生活虚弱，估计发病率为 1:1204 例（1027-1412 年 95%CI 1），死亡率为2020 年的患病率为 1（1642-2488 年的 95% CI 1），比体弱成年人高约 2.6 倍。髋部骨折、紧急剖腹手术、紧急血管手术和泌尿外科手术是老年体弱、心脏骤停患者最常见的手术方式。我们报告说，手术人群的虚弱负担很高，需要复杂、紧急的手术，而且与同龄非虚弱患者相比，围手术期心脏骤停的结果更差。