Comment on “Impact of pre-operative frailty on hospital length of stay in major abdominal oncological surgeries: A prospective, observational study”

Dear Editor, We read with great interest the article by Sharma et al.,[1] titled “Impact of pre-operative frailty on hospital length of stay in major abdominal oncological surgeries: A prospective, observational study”. We congratulate the authors for investigating the impact of frailty in perioperative oncologic surgical patients. Further, we would like to offer a few observations that may add to the clinical utility of the study findings. Firstly, the Fried Frailty Phenotype, despite being a recognised standard for frailty assessment, relies on patient-reported parameters such as exhaustion and weight loss, making it partially subjective. In an oncological population, cancer-related cachexia often overlaps with biological frailty; hence, utilising an entirely objective, performance-based tool such as the Short Physical Performance Battery (SPPB) might provide a more precise and unbiased assessment. The SPPB may better reflect a patient’s physical reserve and functional ability to withstand “surgical stress”. However, this requires further evaluation through dedicated clinical trials. Secondly, it is noted that 47.8% of the patients were identified as frail. This high prevalence highlights an urgent need for intervention in the form of prehabilitation. Multi-disciplinary prehabilitation—incorporating physical, psychological, nutritional, and medical domains—may improve patients’ overall physiological reserves and functional capacity.[2] Robust prospective studies are required to compare “Standard Care” with “Multimodal Prehabilitation” in patients identified as frail before oncological surgeries. Assessment of frailty is a vital step in the comprehensive pre-anaesthetic evaluation of the oncological patient.[3] However, the next frontier for the anaesthesiologist is to mitigate perioperative risks by implementing prehabilitation protocols tailored to each patient’s needs and degree of frailty. Author contributions Both authors contributed equally to conception and design, drafting the article and revising it critically for important intellectual content; and final approval of the version to be published. Study data availability No datasets were generated or analysed during the current study. Disclosure of use of artificial intelligence (AI)-assistive or generative tools The AI tools or language models (LLMs) have not been utilised in the manuscript, except that software has been used for grammar corrections. Declaration of use of permitted tools These tools were not used. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.