The Use of Frailty as a Surgical Risk Assessment Tool in Elderly Patients

With the continued aging of the population, a rising proportion of surgical procedures will be performed in elderly patients. Current surgical decision-making tools rely on subjective judgments and were developed without special geriatric considerations. As a result, they have certain inadequacies that limit their utility in this population. Frailty, described for decades by the medical geriatric community, has just recently begun to be investigated as a surgical risk assessment tool. Identifying the frailty phenotype has been shown by multiple investigators to reliably predict which patients are at increased risk of adverse peri-operative outcomes. Perhaps, most importantly, it is a tool that can potentially discriminate among the elderly, identifying those that warrant heightened concern, "pre-habilitation", or special postoperative attention from those at no increased risk compared to the general population. Alternatively, some patients may be identified as “too frail” to undergo surgery, and alternative nonsurgical treatment options may be considered.