Summary
This narrative review synthesises evidence on frailty—a multidimensional syndrome of reduced physiological reserve—for perioperative clinicians. The authors establish that 30–50% of older patients undergoing major surgery experience frailty, which more than doubles risk of morbidity, mortality, and new functional disability. The review recommends the Clinical Frailty Scale as the most feasible preoperative screening tool and proposes an optimisation pathway addressing physical dysfunction, malnutrition, cognitive impairment, and mental health, with prehabilitation and nutritional intervention as key interventions.
UK applicability
Given the United Kingdom's ageing population and NHS perioperative services, this review is directly applicable to British anaesthetic and surgical practice. The recommendations for frailty screening and optimisation align with UK perioperative best practice and have implications for resource allocation, prehabilitation commissioning, and patient-centred preoperative assessment protocols.
Key measures
Frailty prevalence in older surgical populations; relative and absolute risk associations with morbidity, mortality, and functional outcomes; comparative sensitivity/specificity of frailty instruments (Clinical Frailty Scale, Fried Phenotype, Edmonton Frail Scale, Frailty Index); outcomes related to function, disability, and quality of life
Outcomes reported
The study reports the prevalence of frailty in older patients presenting for major surgery, associations between frailty and adverse perioperative outcomes (morbidity, mortality, disability), and the comparative utility of frailty assessment instruments. It describes approaches to preoperative optimisation including exercise prehabilitation and nutritional supplementation.
Topic tags
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