Perioperatif Dönemde Frailty ve Anestezi Yönetimine Etkileri

Öz

Amaç: Yaşlı nüfusun artışıyla birlikte cerrahi girişim geçiren frail (kırılgan) hasta sayısı giderek artmaktadır. Frailty, azalmış fizyolojik rezerv ve stresörlere karşı yetersiz adaptasyon ile karakterize olup, perioperatif dönemde morbidite ve mortalite açısından önemli bir belirleyicidir. Bu derlemenin amacı, frailty kavramını, patofizyolojik temellerini, değerlendirme araçlarını ve frailty’nin perioperatif anestezi yönetimi üzerindeki etkilerini güncel literatür ışığında incelemektir. Yöntem: Bu derleme, PubMed ve ilgili kılavuz kaynakları kullanılarak yapılan güncel literatür taramasına dayanmaktadır. Frailty tanımı, patofizyolojisi, değerlendirme ölçekleri, perioperatif riskler, anestezi yönetimi, postoperatif deliryum ve nörokognitif bozukluklar ile uluslararası kılavuz önerileri ele alınmıştır. Çalışmaya derleme, sistematik derleme, meta-analiz ve kılavuz niteliğindeki yayınlar dahil edilmiştir. Bulgular: Literatür, frailty varlığının postoperatif komplikasyonlar, uzamış hastanede yatış süresi, yoğun bakım gereksinimi, fonksiyonel bağımsızlık kaybı, deliryum ve mortalite ile güçlü şekilde ilişkili olduğunu göstermektedir. Frail hastalarda anestezik ajanlara duyarlılık artmakta, hemodinamik dalgalanmalara tolerans azalmakta ve postoperatif nörokognitif komplikasyon riski yükselmektedir. Clinical Frailty Scale ve FRAIL ölçeği gibi hızlı tarama araçları, perioperatif risk öngörüsünde pratik ve etkili yöntemler olarak öne çıkmaktadır. Uluslararası kılavuzlar, frailty’nin perioperatif bakımın tüm aşamalarına entegre edilmesini önermektedir. Sonuç: Frailty, perioperatif dönemde hasta güvenliği ve klinik sonuçlar açısından kritik öneme sahip bir klinik durumdur. Anestezi pratiğinde frailty’nin sistematik olarak değerlendirilmesi, risk sınıflamasının iyileştirilmesine ve bireyselleştirilmiş perioperatif yönetim stratejilerinin geliştirilmesine olanak tanır. Multidisipliner yaklaşım, prehabilitasyon ve deliryum önleyici stratejiler, frail hastalarda daha iyi klinik sonuçlar elde edilmesinde temel unsurlar olarak öne çıkmaktadır.

Anahtar Kelimeler

• frailty
• anestezi
• perioperatif bakım
• yaşlı hasta
• deliryum

Destekleyen Kurum

Bu çalışmanın hazırlanması ve yayımlanması sürecinde herhangi bir kurum veya kuruluştan finansal destek alınmamıştır.

Etik Beyan

Bu çalışma bir derleme olup, insan veya hayvan katılımcılar üzerinde herhangi bir girişim, veri toplama ya da deneysel işlem içermemektedir. Bu nedenle etik kurul onayı ve bilgilendirilmiş onam gerekmemektedir.

Teşekkür

Bu çalışmada teşekkür edilmesi gereken herhangi bir kişi veya kurum bulunmamaktadır

Effects of Frailty on Perioperative Anesthesia Management

Öz

Objective: With the global increase in life expectancy, the number of frail older patients undergoing surgical procedures continues to rise. Frailty is characterized by reduced physiological reserve and impaired adaptation to stressors and has become a major determinant of perioperative morbidity and mortality. This review aims to examine the concept of frailty, its pathophysiological basis, commonly used assessment tools, and the impact of frailty on perioperative anesthetic management in light of current evidence. Methods: This narrative review is based on a comprehensive literature search of PubMed and relevant international guidelines. Studies addressing the definition and pathophysiology of frailty, frailty assessment instruments, perioperative risks, anesthetic management strategies, postoperative delirium and neurocognitive disorders, and guideline-based recommendations were evaluated. Review articles, systematic reviews, meta-analyses, and clinical practice guidelines were included. Results: The literature consistently shows that frailty is strongly associated with increased postoperative complications, prolonged hospital stay, greater intensive care unit requirements, loss of functional independence, delirium, and mortality. Frail patients demonstrate increased sensitivity to anesthetic agents, reduced tolerance to hemodynamic fluctuations, and a higher risk of postoperative neurocognitive complications. Rapid screening tools, such as the Clinical Frailty Scale and the FRAIL scale, provide practical and effective methods for perioperative risk prediction. Current international guidelines emphasize integrating frailty assessment into all phases of perioperative care. Conclusion: Frailty is a critical clinical condition that significantly influences perioperative outcomes and patient safety. Systematic frailty assessment in anesthetic practice enhances perioperative risk stratification and supports individualized management strategies. Multidisciplinary care, prehabilitation, and delirium-prevention strategies play a central role in optimizing outcomes for frail surgical patients.

Anahtar Kelimeler

• Frailty
• Anesthesia
• Perioperative care
• Older adults
• Delirium

Destekleyen Kurum

No financial support was received from any institution or organization for the preparation and publication of this study.

Etik Beyan

This study is a review article and does not involve any human or animal participants, data collection, or experimental procedures. Therefore, ethical committee approval and informed consent were not required.

Teşekkür

The authors declare that there are no acknowledgements for this study.

Kaynakça

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