The American College of Surgeons (ACS) and Center for Medicare Services (CMS) Age-Friendly initiative emphasizes the importance of perioperative assessment of mobility and cognition for older adults undergoing surgical interventions to address their higher risk of mobility impairment and increased fall risk after surgical interventions. This project aimed to screen for geriatric impairments (slow gait speed, increased fall risk) preoperatively and observe changes in the immediately postoperative (6 weeks) after elective outpatient based urologic or urogynecologic non-malignant procedures. We hypothesized that women with slow gait speed (defined as <1 m/s) will have further decline and increased fall risk in the immediate post-operative period in adults with baseline impairment.

A prospective study of older adult women and men undergoing outpatient surgery for benign urologic and urogynecologic conditions was conducted. Eligible individuals were ≥70 years old or ≥65 years old with a visible mobility or balance impairment indicated by the use of a mobility/balance aid (cane, walker, etc.). Adults who were undergoing surgical procedures for malignancy were excluded. Participants were screened and enrolled at a preoperative appointment and their frailty status was established with use of the electronic frailty index (eFI). Baseline assessments included gait speed and fall risk. Gait speed was assessed using the validated 4-meter gait speed test. Fall risk was determined using the ZIBRIO Stability Pro scale, a validated fall risk assessment scale. All measures were repeated 1-2 weeks and at 6 weeks postoperatively. At their 6-week postoperative visit, qualitative assessments of patient experience with perioperative geriatric assessment were conducted. Univariate analyses were applied to characterize the baseline patient population. Bivariate analyses are applied to observe changes in geriatric impairments postoperatively at 2 and 6 weeks.

To date, we have invited 32 individuals to participate and recruited 26 older adults (23 women and 3 men) undergoing outpatient surgery with mean age 77.21 ± 5.17 years. The mean eFI (baseline) is 0.15 ± 0.09 characterizing them as mildly frail. The mean baseline gait speed of 1.1±0.34 meters/second indicate slow gait with elevated risk of mobility impairment. Baseline fall risk as measured by the ZIBRIO stability scale is 4.62±1.84 indicating high-moderate fall risk, specifically with 58% chance of falling without 12 months.  Among frail participants, there is no statistically significant difference between baseline, 2-week, or 6-week gait speed based on frailty status [baseline (1.03 ± 0.27 m/s, n=11, 2week gait speed (0.96 ± 0.16 m/s, n=5), 6-week gait speed 1.07±0.27 m/s).

At baseline, mild frailty and high-moderate fall risk is present among older adults undergoing outpatient surgery.

Perioperative morbidity may increase among older adults with baseline frailty and higher fall risk. Prehabilitation strategies may be indicated in this patient population.