Frailty and sarcopenia as predictors of postoperative outcomes in elderly patients undergoing lower limb orthopedic surgeries in South India

Background and Aims: As the aging Indian population expands, anesthesiologists will increasingly encounter frail surgical patients. We aimed to study the prevalence of frailty, its association with sarcopenia, and its impact on postoperative outcomes among older patients (>65 years) undergoing lower limb orthopedic surgeries. Material and Methods: Frailty was assessed using the Clinical Frailty Score (CFS), and values were compared with ultrasound-guided quadriceps muscle thickness measurements for sarcopenia, after normalizing for body mass index (BMI) and body surface area (BSA). A comparison of perioperative characteristics and postoperative outcomes with frailty was made using Spearman’s correlation and the Chi-square test. An ROC curve was plotted to evaluate the validity of the normalized quadriceps muscle thickness value in diagnosing frailty. Results: The proportion of frailty in our study population was 80.1% with a significant association for sarcopenia (Spearman’s correlation coefficient -0.182 and -0.237 for quadriceps muscle thickness normalized for BMI and BSA, P value < 0.001), age (72.35 (64.2, 80.5) versus 68.76 (64.97,72.55) years, P = 0.001), ASA classification ( P < 0.001), and surgical type ( P = 0.006). Compared to the nonfrail, patients with frailty had higher rates of postoperative ICU admission ( P = 0.003), increased lengths of ICU ( P = 0.005) and hospital stay ( P = 0.005), and more postoperative complications (39.4% vs 12.9% patients, ( P = 0.001), OR 3.061 (1.636-5.730)). Conclusion: Frailty occurs in a large percentage of older orthopedic patients and significantly impacts postoperative outcomes.