Paper Title

Background: Frailty is associated with poor surgical outcomes and prolonged hospital admissions. Increasing age and frailty are independent predictors of mortality in patients with peripheral artery disease. Given there is an elevated risk of major adverse cardiovascular events and mortality following vascular surgery, prehabilitationhas the potential to improve outcomes for these patients.The aim of this project is to create a standardized proforma and referral pathways to other specialty services including geriatric medicine, dietician, physiotherapy to offer holistic care and create a create a tailored plan. Method: The experience of a Vascular Surgery unit of quaternary center in Australia is described where a standardized proforma is being built to assist in identifying frail patients who will benefit from a prehabilitation action plan. Currently patients undergoing major vascular surgery are reviewed by a junior doctor in surgical pre-admission clinic (PAC) and in anaesthetic PAC. The focus of these clinics is to assess the patient’s current cardiovascular fitness and create an individualisedperioperative plan. Results: The proforma includes a check list of demographic data and co-morbidities to identify frail patients. Bedside assessments are inserted into the proforma including random blood glucose level and body mass index. Patients are referred to physiotherapist for supervised aerobic exercise programs, dietician to optimise nutrition, an endocrinologist and geriatrician to optimise comorbidities in addition to PAC. Conclusion:Given the success of prehabilitation in surgical management of otherfrail patients, we anticipate similar results with vascular surgery patients with reduced cardiac and respiratory complications and reduced length of hospital stay.