well as early involvement of nutrition counseling and physical therapy for pre-procedural optimization.


Ultimately, as interventional radiologists, it is up to us to uncover the interplay between frailty and IR procedural outcomes and to incorporate this knowledge into our clinical practice to better serve the growing geriatric patient population.


References


1. Mather M, Jacobsen L, Pollard K. Aging in the United States. Population Bulletin 70, no. 2 (2015).


2. Lin HS, McBride RL, Hubbard RE. Frailty and anesthesia—risks during and post-surgery. Local Reg Anesth. 2018;11:61–73.


3. Amrock LG, Deiner S. Perioperative frailty. Int Anesthesiol Clin. 2014;52(4):26–41.


4. Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin. 2017 Sep;67(5):362–377.


Frailty assessment prior to IO procedures can guide appropriate dosage and selectivity in transarterial chemotherapy and radiotherapy, potentially limiting risk of toxicity in high-risk patients.


and its impact on postprocedural outcomes is currently lacking.


Frailty and IR While an interventional radiology procedure such as transarterial chemoembolization is seen as a minimally invasive, low-risk oncological therapy, it still poses a myriad of physiological challenges for patients. The procedure itself delivers chemotherapy agents to the liver, which carries a higher likelihood of toxicity in frail patients with altered metabolism. Patients undergo periprocedural fasting, opioid analgesics and anesthetic agent. They experience postprocedural pain, nausea and vomiting, an unfamiliar hospital environment and a period of immobility. Although these series of minor insults may be inconsequential for a healthy patient with sufficient physiological reserve, they can result in higher risk of short-term complications and long-term mortality in frail patients, as we have observed from our own institutional analysis.14


22 IRQ | FALL 2021


Conclusion Frailty is emerging as an important determinant of healthcare and surgical outcomes in the elderly population and is increasingly being considered to guide treatment decisions across medical and surgical specialties. Routine assessment and documentation of frailty in IR has significant potential to improve patient outcomes in our specialty. For example, frailty assessment prior to IO procedures can guide appropriate dosage and selectivity in transarterial chemotherapy and radiotherapy, potentially limiting risk of toxicity in high-risk patients. It can also guide the choice of antibiotic prophylaxis to decrease risk of postoperative infection and anesthetic techniques such as the use of neuraxial blockades to reduce opioid consumption. Frailty can guide selective use of specialized hospital resources such as involvement of palliative care and admission to the Acute Care for Elders (ACE) unit for observation, as


5. Czobor NR, Lehot JJ, Holndonner-Kirst E, Tully PJ, Gal J, Szekely A. Frailty in patients undergoing vascular surgery: A narrative review of current evidence. Ther Clin Risk Manag. 2019;15:1217–1232.


6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group. J Gerontol A Biol Sci Med Sci. 2001 Mar; 56(3):M146–56.


7. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.


8. Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, Feng S. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology. 2017 Aug;66(2):564–574.


9. Xue QL. The frailty syndrome: Definition and natural history. Clin Geriatr Med. 2011;27(1):1–15.


10. McIsaac DI, MacDonald DB, Aucoin SD. Frailty for perioperative clinicians: A Narrative review. Anesth Analg. 2020 Jun;130(6):1450-1460.


11. Ko FC. Preoperative frailty evaluation: A promising risk-stratification tool in older adults undergoing general surgery. Clin Ther. 2019;41(3):387–399.


12. Fozouni L, Mohamad Y, Lebsack A, Freise C, Stock P, Lai JC. Frailty is associated with increased rates of acute cellular rejection within 3 months after liver transplantation. Liver Transpl. 2020 Mar;26(3):390–396.


13. Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. The 5-Factor Modified Frailty Index in the geriatric surgical population. Am Surg. 2020 Dec. doi: 10.1177/0003134820952438.


14. Rabei R, Vakil P, True-Yasaki A, Phuong J, Kohi M, Lokken R, Lehrman E, Kolli K, Kohlbrenner R, Fidelman N. Abstract No. 391 Frailty is predictive of complications after transarterial chemoembolization. JVIR. 2020 Mar;31(3):S176.


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