Perceptions of Frailty and Prehabilitation Among Thoracic Surgeons: Findings From a National Survey

Abstract

Background: 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 current practices of thoracic surgeons managing frail patients. Methods: A 144-question survey developed in collaboration with the University of Chicago Survey Lab was sent to CTSnet.org members who identified as general thoracic surgeons, practiced in the United States, and had publicly available emails. Responses were collected from August 12 to September 11, 2022. Both fully and partially (at least 20%) completed surveys were included in a descriptive statistical analysis. Results: After 2796 surveys were administered, 342 surgeons responded. Surgeons were in practice a median of 23 years (range, 1-50 years) at academic (63.4% [187/295]) or community (36.6% [108/295]) centers. Most surgeons believed it important to assess frailty preoperatively (83.9% [287/342]), but only 28% (97/342) of surgeons performed routine frailty assessment. Barriers to routine frailty assessment included lack of tools (80.0% [32/40]), training (59.0% [23/39]), and staffing (56.4% [22/39]). Whereas most surgeons believed that frailty could be mitigated (72.2% [247/342]), only 49.5% (156/315) prescribed prehabilitation. Up to 78.7% (203/263) of surgeons would delay or cancel surgery for patient frailty, depending on disease cause. Conclusions: Thoracic surgeons recognize that frailty is an established risk factor for perioperative morbidity and mortality; however, there is high variability in diagnosis and management of frailty. Guidelines are needed to establish best practices for screening and mitigation to optimally treat frail patients.