Perioperative Decision-Making in a Multidisciplinary Preoperative Clinic: Associations of Frailty Assessment with Treatment Recommendations and Mortality in a Non-Oncological Cohort

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Introduction Frailty is increasingly recognised as a dynamic condition; however, in patients referred for surgery, particularly those with advanced comorbidity, baseline frailty remains a strong marker of short-term prognosis. The role of Comprehensive Geriatric Assessment (CGA) in perioperative medicine, continues to evolve, particularly in aligning treatment plans with patient priorities and anticipated benefit. Methods We conducted a retrospective observational study of a cohort of consecutive non-oncological patients referred to a multidisciplinary geriatric perioperative assessment clinic. Baseline frailty was categorised after CGA and by using the Clinical Frailty Scale (CFS). The primary outcome was recommendation of a non-operative /conservative /palliative treatment pathway following CGA and shared decision-making. Secondary outcomes included mortality at 3 months and 1 year. Associations were explored using logistic regression and categorical analyses. Results Eighty-nine patients were included. Increasing frailty was strongly associated with a non-operative or palliative pathway (OR 3.70 per one-point increase in CFS, 95% CI 1.90–7.20; p< 0.001). 0% patients with CFS 1–4 were recommended a palliative pathway, compared with 34% of those with CFS 5–6 and 80% of those with CFS 7–9. Frailty was also associated with increased short- and mid-term mortality among patients with higher CFS. The associations were consistent across surgical subgroups. Conclusion In a non-oncological perioperative cohort, baseline frailty was strongly associated with both treatment recommendations and mortality. Frailty assessment provided essential prognostic context to support shared decision-making and appropriate perioperative planning. These findings highlight the value of CGA in perioperative medicine.