A frail elderly patient was scheduled for elective hip replacement at a surgical cold site. The intraoperative course was uneventful. In recovery, the patient developed suspected ST-elevation myocardial infarction and was transferred to a local hospital (approximately 20 minutes away). Coronary angiography revealed Takotsubo cardiomyopathy. The patient suffered a cardiac arrest en route to ICU, and CPR was unsuccessful.

Commentary:

Postoperative morbidity can occur unexpectedly, even with careful preoperative screening.  In standalone surgical units there must be facilities for timely transfer of critically ill patients, especially if older and frail patients are operated on.

The Centre for Perioperative Care/British Geriatric Society guidance, and GIRFT guidance recommends that frailty scores be documented using the CFS at surgical referral, preoperative assessment and admission.^1,2 The CPOC guidance further recommends comprehensive multidisciplinary assessment for CFS ≥5 for all those aged over 65 years.

References

1. Centre for Perioperative Care, British Geriatrics Society. Guideline for perioperative care for people living with frailty undergoing elective and emergency surgery. 2021. Available: https://www.cpoc.org.uk/sites/cpoc/files/documents/2021-09/CPOC-BGS-Frailty-Guideline-2021.pdf

2. Getting it Right First Time, British Geriatric Society. Six steps to better care for older people in acute hospitals: Guidance for managing the GIRFT overall frailty pathway- geriatric medicine. 2023. Available: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2023/07/GIRFT-BGS-Six-Steps-to-Better-Care-for-Older-People-FINAL-V2-July-2023.pdf