Screening and Diagnosing Frailty in the Cardiac and Noncardiac Surgical Patient to Improve Safety and Outcomes

Frailty as a marker of aging has been well studied in the geriatric literature, where it has been established that chronological age does not necessarily correlate with biological age in terms of predicting patient outcomes. Over the past decade, the study of frailty has also flourished in the surgical and perioperative literature. This is fitting, given that the elderly population is the most rapidly growing segment in the United States, and by some estimates, more than half of all surgeries in the United States are performed on patients older than 65 years of age. Frailty has been associated with higher mortality, increased rates of postoperative complications, longer hospital stays, and higher rates of discharge to assisted living facilities. Identification of frail patients in the preoperative period has valuable implications across the perioperative spectrum. Specifically, it: allows clinicians to have more meaningful goals of care and risk-benefit discussions with patients and their families before surgery; expedites targeted interventions and allocation of resources to the patients who need it the most; and facilitates multidisciplinary team discussions on disposition planning.