Feasibility of preoperative patient self-assessed frailty: a single-centre pilot study

Background Frail patients are at risk of poorer perioperative outcomes, with early identification facilitating shared decision-making and care planning. Preoperative self-assessment is understudied and may support early screening. We developed and piloted a modified Rockwood Clinical Frailty Scale (CFS) using lay language for patient self-assessment before major surgery. Our aim was to pilot the feasibility of preoperative patient self-assessment of frailty using the modified tool. Agreement with a clinician CFS assessment was evaluated. Methods We recruited 80 patients out of those aged ≥65 yr attending for preoperative assessment at a single centre in the UK. Participants self-assessed using the modified CFS, with a clinician blinded to this completing a parallel standard CFS assessment. Agreement was evaluated using Cohen's kappa and a linear mixed-effects model, treating the CFS as both a 9-point scale and as three categories. A post hoc subgroup analysis was undertaken in participants aged ≤74 yr and those aged >74 yr. Results Eighty participants were screened to determine interest and then recruited with a median age of 74 yr between April 2023 and March 2024. Seven (8.8%) participants were frail (CFS ≥5). Seventy-three participants (91%) successfully completed the self-assessment. Seventy-seven percent of self-assessments matched the clinician assessment exactly or were within 1 point. Overall agreement was moderate (kappa coefficient=0.433, P <0.001). This was stronger when treating the CFS as a 9-point scale and in participants aged ≤74 yr. Where disagreement occurred, patients tended to overestimate their frailty with respect to the clinician (mean difference, 0.263 CFS points; P =0.055). Discussion This single-centre pilot study evaluated the feasibility of preoperative frailty self-assessment. We report that patients can complete a modified CFS achieving moderate agreement with the clinician's CFS assessment. This study provides an important foundation for further development and validation work to establish feasibility and suitability to incorporate within early preoperative screening initiatives.