Aims: Preoperative frailty is associated with increased risk of adverse outcomes. In 2017, McIsaac and colleagues’ systematic review found few interventions were tested to improve outcomes in this population and evidence was low-quality [1]. We aimed to systematically review the evidence for multicomponent perioperative interventions in frail patients that has emerged since McIsaac et al.’s review.
Methods: PUBMED, EMBASE, Cochrane, and CINAHL databases were searched for English-language studies published since January 1, 2016, that evaluated multicomponent perioperative interventions in frail patients identified with validated frailty measures. Multicomponent interventions had to address at least two domains and not constitute enhanced recovery after surgery protocols. Quality was assessed using Risk of Bias 2.0 and National Institute of Health Quality Assessment Tool.
Results: Of 2454 articles screened, five studies (N = 511 patients) in elective oncologic gastrointestinal surgical population were included. 413 (80.8%) patients met frailty criteria, with 179 (43.3%) receiving multicomponent interventions and 234 (56.7%) standard care. Multicomponent interventions were all applied in the preoperative period. Two studies also applied interventions postoperatively. All interventions addressed exercise and nutritional domains with variability in timing, delivery, and adherence. Multicomponent interventions were associated with reduced postoperative complications, loss of functional independence, length of stay, and mortality. Few studies reported patient-centred outcomes. Overall, quality of evidence was good.
Conclusions: This systematic review provides evidence that frail surgical patients undergoing elective oncologic gastrointestinal surgery may benefit from targeted multicomponent perioperative interventions. Further research is needed to evaluate optimal intervention delivery and to assess effectiveness on patient-centred outcomes.