Summary
This prospective multicenter cohort study compared two preoperative frailty assessment instruments (mFI and CFS) in 645 adults aged ≥65 undergoing elective noncardiac surgery. Both instruments demonstrated significant associations with death or new patient-reported disability within 90 days (CFS adjusted OR 2.51, mFI adjusted OR 2.60), with comparable predictive accuracy. The Clinical Frailty Scale was found to be more practical for clinical use, requiring less time and generating fewer missing data points whilst maintaining equivalent predictive performance.
UK applicability
These findings are directly applicable to UK surgical practice, as both instruments are used in UK preoperative assessment protocols. The identification of frailty as the only significant independent predictor of adverse outcomes supports implementation of frailty screening before elective surgery in UK hospital systems, with the CFS potentially preferred for scalable adoption due to superior feasibility.
Key measures
Modified Fried Index (mFI) and Clinical Frailty Scale (CFS) for frailty classification; adjusted odds ratios for death or new disability; true positive and false positive rates; length of stay; institutional discharge rates; instrument usability metrics
Outcomes reported
The study measured death or patient-reported new disability at 90 days post-surgery as the primary outcome, along with secondary outcomes including safety incidents, length of stay, and institutional discharge. Tertiary outcomes assessed the practical utility of two frailty instruments: ease of use, usefulness, clinical importance, and feasibility.
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