SNAP-3: characteristics of specific subgroups of older patients undergoing surgery in the UK

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BACKGROUND: The SNAP-3 study reported one in five older surgical patients in the UK were living with frailty and two in three with multimorbidity. We now report characteristics and outcomes of specific subgroups of patients including individuals aged ≥85 yr, undergoing day or inpatient surgery and elective or emergency surgery, and undergoing common specialty procedures including orthopaedics, urology, colorectal surgery, and hip arthroplasty. METHODS: This prospective observational cohort study recruited patients aged ≥60 yr undergoing surgery during five days in March 2022 across 214 UK hospitals. Daycase, inpatient, elective, and emergency surgery was included; minor or superficial surgery was excluded. Data on patient characteristics, frailty, and multimorbidity were collected. Outcomes were medical complications including delirium, collected prospectively, postoperative morbidity and death, and length of stay. Descriptive statistics were used to analyse demographic and outcome data for these subgroups defined a priori. RESULTS: Of 7821 participants recruited, 7134 were available for analysis. Frailty was most prevalent amongst those undergoing hip fracture surgery (58.2%; 280/481); aged ≥85 yr (49.3%; 365/740); or undergoing emergency (31.4%; 668/2126) or orthopaedic procedures (30.6%; 630/2056). Participants undergoing emergency procedures had a median postoperative stay of 5 (interquartile range 1-13) days versus 1 (interquartile range 0-3) days compared with participants undergoing elective procedures, with delirium occurring in 16.3% (348/2138) versus 2.7% (134/4922), respectively. Postoperative morbidity and 30-day mortality were highest in those undergoing hip fracture surgery (morbidity 85.3% [413/484], mortality 5.0% [24/484]); aged ≥85 yr (morbidity 49.1% [367/747], mortality 3.9% [29/741]) and undergoing emergency procedures (morbidity 49.5% [1058/2138], and mortality 3.0% [64/2124]). CONCLUSIONS: This snapshot of surgical patients in the UK highlights the high prevalence of frailty, postoperative morbidity, and mortality in key surgical subgroups, reinforcing the urgent need for comprehensive age-appropriate perioperative services tailored to these populations.

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