Perceptions of Frailty and Prehabilitation Among Thoracic Surgeons: Findings from a National Survey
Presented During:
Monday, May 8, 2023: 3:24PM - 3:27PM
Los Angeles Convention Center
Posted Room Name:
Exhibit Hall
Abstract No:
P0143
Submission Type:
Abstract Submission
Authors:
Johnathan Kent (1), Julia Chavez (2), Ally Wang (3), Savanna Kerstiens (1), Daniel Rubin (4), Lauren Gleason (5), Andrea Landi (5), Megan Huisingh-Scheetz (5), Darren Bryan (1), Mark Ferguson (1), Jessica Donington (1), Maria Lucia Madariaga (1)
Institutions:
(1) Department of Surgery, Section of Thoracic Surgery, University of Chicago, Chicago, IL, (2) Pritzker School of Medicine, University of Chicago, Chicago, IL, (3) University of Chicago, Chicago, IL, (4) Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, (5) Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago, Chicago, IL
Submitting Author:
Johnathan Kent
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Department of Surgery, Section of Thoracic Surgery, University of Chicago
Department of Surgery, Section of Thoracic Surgery, University of Chicago
Co-Author(s):
Julia Chavez
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Pritzker School of Medicine, University of Chicago
Pritzker School of Medicine, University of Chicago
Ally Wang
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University of Chicago
University of Chicago
Savanna Kerstiens
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Department of Surgery, Section of Thoracic Surgery, University of Chicago
Department of Surgery, Section of Thoracic Surgery, University of Chicago
Daniel Rubin
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Department of Anesthesia and Critical Care, University of Chicago
Department of Anesthesia and Critical Care, University of Chicago
Lauren Gleason
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Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago
Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago
Andrea Landi
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Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago
Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago
Megan Huisingh-Scheetz
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Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago
Department of Medicine, Section of Geriatric & Palliative Medicine, University of Chicago
Darren Bryan
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Department of Surgery, Section of Thoracic Surgery, University of Chicago
Department of Surgery, Section of Thoracic Surgery, University of Chicago
*Mark Ferguson
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Department of Surgery, Section of Thoracic Surgery, University of Chicago
Department of Surgery, Section of Thoracic Surgery, University of Chicago
*Jessica Donington
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Department of Surgery, Section of Thoracic Surgery, University of Chicago
Department of Surgery, Section of Thoracic Surgery, University of Chicago
♦Maria Lucia Madariaga
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Department of Surgery, Section of Thoracic Surgery, University of Chicago
Department of Surgery, Section of Thoracic Surgery, University of Chicago
Presenting Author:
Johnathan Kent
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Abstract:
Objectives: Frailty is associated with increased perioperative morbidity and mortality. How thoracic surgeons recognize, measure and mitigate frailty in their daily clinical practice is unknown. We administered a national survey to determine the experiences of thoracic surgeons managing frail surgical patients.
Methods: A 144-question web-based survey designed with input from the University of Chicago Survey Lab assessing perceptions of frailty and prehabilitation was sent to members of CTSnet.org who identified as thoracic surgeons, practiced in the United States, and had publicly available emails. Responses were collected from August to September 2022. Both fully and partially completed surveys were included in a descriptive statistical analysis.
Results: Of 2,796 surveys administered, 286 (10%) were fully and 56 (2%) were partially completed. Surgeons were 76.3% male (261/292), 80.1% white (225/281) and in practice a median of 23 years (range 1-50) at academic (63.4%, 187/295) or community (34.2%, 101/295) centers. Most surgeons were familiar with frailty (92.7%, 317/342) and believed it was important to assess (83.9%, 287/342). Frailty was estimated to be present in a median of 3 new clinic patients (range 0-30) per week. Routine frailty assessment was performed by 28% (97/342) of surgeons, who used observation alone (26.0 %, 89/332) or formal tools (7.9%, 27/342). Barriers to routine frailty assessment included lack of tools (80.0%, 32/40), training (59.0%, 23/39), and staffing (56.4%, 22/39). While most surgeons believed that frailty could be mitigated (72.2%, 247/342), only 49.5% (156/315) prescribed prehabilitation, recommending nutritional supplements (80.0%, 124/155), mild to moderate exercise (64.5%, 100/155), and physical therapy (61.3%, 95/155). Up to 78.7% (203/263) of surgeons would delay or cancel surgery depending on disease etiology (Table 1). Most surgeons favor establishing surgical guidelines for frailty screening and management (69.9%, 239/294). Only 24.1% (71/295) of surgeons work in hospitals that offer specialized perioperative care programs for frail surgical patients.
Conclusions: Thoracic surgeons accept that frailty is an established risk factor for perioperative morbidity and mortality; however, there appears to be high variability in diagnosing and managing frailty. Guidelines are needed to establish best practices for frailty screening and mitigation techniques to optimally treat frail patients.
Methods: A 144-question web-based survey designed with input from the University of Chicago Survey Lab assessing perceptions of frailty and prehabilitation was sent to members of CTSnet.org who identified as thoracic surgeons, practiced in the United States, and had publicly available emails. Responses were collected from August to September 2022. Both fully and partially completed surveys were included in a descriptive statistical analysis.
Results: Of 2,796 surveys administered, 286 (10%) were fully and 56 (2%) were partially completed. Surgeons were 76.3% male (261/292), 80.1% white (225/281) and in practice a median of 23 years (range 1-50) at academic (63.4%, 187/295) or community (34.2%, 101/295) centers. Most surgeons were familiar with frailty (92.7%, 317/342) and believed it was important to assess (83.9%, 287/342). Frailty was estimated to be present in a median of 3 new clinic patients (range 0-30) per week. Routine frailty assessment was performed by 28% (97/342) of surgeons, who used observation alone (26.0 %, 89/332) or formal tools (7.9%, 27/342). Barriers to routine frailty assessment included lack of tools (80.0%, 32/40), training (59.0%, 23/39), and staffing (56.4%, 22/39). While most surgeons believed that frailty could be mitigated (72.2%, 247/342), only 49.5% (156/315) prescribed prehabilitation, recommending nutritional supplements (80.0%, 124/155), mild to moderate exercise (64.5%, 100/155), and physical therapy (61.3%, 95/155). Up to 78.7% (203/263) of surgeons would delay or cancel surgery depending on disease etiology (Table 1). Most surgeons favor establishing surgical guidelines for frailty screening and management (69.9%, 239/294). Only 24.1% (71/295) of surgeons work in hospitals that offer specialized perioperative care programs for frail surgical patients.
Conclusions: Thoracic surgeons accept that frailty is an established risk factor for perioperative morbidity and mortality; however, there appears to be high variability in diagnosing and managing frailty. Guidelines are needed to establish best practices for frailty screening and mitigation techniques to optimally treat frail patients.
Categories:
Safety, Quality, and Teamwork
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