Frailty is a critical determinant of postoperative outcomes in elderly patients. Several frailty assessment tools, including the Modified Frailty Index (MFI-5) and the Charlson Comorbidity Index (CCI), have been proposed to predict complications, hospital length of stay (LoS), and critical care admission. However, their comparative predictive value across a broad spectrum of non-cardiac surgeries remains unclear. The purpose of this study was to assess the predictive ability of MFI-5 and CCI in predicting critical care admission and length of stay (LoS).

This single-centre retrospective study analysed data from patients over 65 years of age who attended the preoperative assessment clinic at the Mater Misericordiae University Hospital (MMUH), Dublin, between November and December 2023. MFI-5 and CCI scores were calculated, and their ability to predict hospital LoS (>5 days) and critical care admission was assessed using area under the receiver operating characteristic curve (AUROC) analysis.

Data from 100 patients were included. Critical care admission was required for 20 patients, and the average hospital length of LoS was 4.5 days. AUROC analysis demonstrated that neither the MFI-5 nor CCI were predictive of critical care admission or extended LoS in this cohort.

The findings suggest that MFI-5 and CCI alone may not be sufficient to predict critical care admission or hospital LoS in elderly patients undergoing non-cardiac surgery. Given the multifactorial nature of postoperative risk, future models integrating frailty indices with surgical and anaesthesia-specific factors may enhance predictive accuracy, improve risk stratification, and optimize perioperative resource allocation.

Older patients are often underrepresented in clinical trials investigating the treatment of coronary drug-eluting stent (DES) restenosis, but outcome data is urgently needed in an ageing society. Thus, the aim of this observational, retrospective study was to close this lack of evidence.

Between January 2007 and February 2021, 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany. We compared the rates of cardiac death, myocardial infarction (MI) and repeat revascularization in 1105 patients (31.5 %) older than 75 years with 2406 patients (68.5 %) younger than 75 years. Survival was analyzed using the Kaplan-Meier method. Differences between the groups were tested with the log-rank test. Conventional multivariable analysis with adjustment for relevant variables was performed.

Older patients were more frequently female (30.1 % vs. 17.9 %, p < 0.001) and presented less frequently with stable angina (67.8 % vs. 72.0 %, p < 0.001). After 10 years, the rates of cardiac death were 56.8 % in older patients and 27.4 % in younger patients (HRadj, 2.45 [95 % CI, 2.09-2.88], p < 0.001). Accounting for the risk of death, no difference was found regarding the rates of MI while target lesion revascularization (TLR) occurred less frequently in older patients (24.2 % vs. 33.7 %; HRadj, 0.77 [95 % CI, 0.66-0.89], p < 0.001).

In the long-term, rates of cardiac death after percutaneous coronary intervention of DES-ISR were higher and TLR rates were lower in patients older than 75 years. There was no difference in the rates of MI.

IntroductionCharacteristics and the impact of frailty on adult solid organ transplant recipients have not been clearly described. The purpose of this integrative review was to identify characteristics of frailty and associations between frailty and patient mortality and graft failure in adult solid organ transplant recipients.MethodsAn integrative literature review was performed using Cooper's integrative methodology. PubMed, Excerpta Medica, and the Cumulative Index of Nursing and Allied Health Literature databases were searched using the terms frailty and transplant. Inclusion criteria were primary research reports, written in English, focusing on adult solid organ transplant recipients, and including graft or patient survival outcomes.ResultsThe review included 35 articles, were largely retrospective, and published between 2015 and 2023 in 11 different countries. Most studies were single-center studies that were not theory-based, and liver transplant recipients were highly represented. Males outnumbered females in the majority of studies and White race was represented in half of the studies. Most studies used one strategy to measure frailty, and modified versions of the Physical Frailty Phenotype were the measurement used most often. Of the 35 articles that investigated the association of frailty with patient mortality, 44 measures were used, and of those, 32 showed a significant association. For graft failure, of the 10 studies included, half showed a significant association between frailty and graft failure.ConclusionThis integrative review offers insights into the characteristics and the association between frailty, patient mortality, and graft failure.

To investigate the relationship between handgrip strength (HGS) and sex, anthropometrics, body composition, and cardiovascular fitness has not been well studied in children, adolescents, and young adults.

A single-center retrospective review of patients <25 years old without known heart disease and referred for clinical cardiopulmonary exercise testing was performed. Each patient underwent HGS testing, bioelectrical impedance body composition analysis, and cardiopulmonary exercise testing. Relationships between variables were assessed using the Pearson correlation coefficient, linear regression, cubic spline, and multivariable analysis. Comparisons by sex were performed using the Student t test.

The study included 316 patients without heart disease (age 15.1 ± 2.4 years old; 35% male). Male patients had greater peak dominant (34.4 ± 11.9 kg vs 27.8 ± 6.2 kg; P < .001) and nondominant (32.1 ± 11.1 kg vs 25.3 ± 6.0 kg; P < .001) HGS than female patients, with these differences more noticeable in the teenage years. Peak dominant HGS averaged 30.2 ± 9.3 kg and was correlated with age (r = 0.49, P < .001) and weight (r = 0.56, P < .0001); peak dominant HGS was even more strongly correlated with total body skeletal muscle mass (r = 0.80, P < .001), peak oxygen consumption (mL/min) (r = 0.69, P < .0001), and peak work rate (r = 0.70, P < .001).

HGS is strongly associated with total and segmental skeletal muscle mass, peak work rate, and peak oxygen consumption. Sex-based differences in handgrip strength values emerge in mid-teenage years in parallel to expected pubertal changes.

A randomized controlled trial was conducted to examine the effects of a home-based multicomponent exercise programme on frailty in patients who underwent cardiac surgery.

A convenience sample of 92 patients who underwent cardiac surgery at two medical centres in Taiwan were recruited and randomly allocated to the intervention (n = 46) and control (n = 46) groups. The intervention group underwent a 12-week home-based multicomponent exercise programme, including individual nursing consultation, home-based exercise intervention, nutritional assessment and guidance, and continuous support. The control group did not receive any interventions. Frailty was assessed with the Fried frailty phenotype at baseline, 6 weeks, and 12 weeks. The prevalence rates of prefrailty and frailty at baseline were 67 and 33%, respectively, and no statistically significant differences in frailty status were noted between the two groups at baseline. However, patients in the intervention group demonstrated significantly greater improvements in their frailty scores, handgrip strength, and physical activity than the control group at 6 and 12 weeks post-intervention, with no adverse events reported.

A home-based multicomponent exercise programme is safe and effective in improving frailty outcomes among post-cardiac surgery patients and is suitable for application in clinical practice. Future studies with larger sample sizes and long-term follow-up are needed to verify the long-term effects of this home-based multicomponent exercise programme.

ClinicalTrials.gov: NCT04332887.

Study DesignRetrospective cohort study.ObjectivesPreoperative risk stratification using frailty is common for adults but difficult to apply to pediatric populations. We aimed to identify risk factors indicating physiologic vulnerability and predict perioperative complications in children with neuromuscular scoliosis (NMS) and to create a prediction model for physiological vulnerability (PV-5).MethodsPatients with NMS were identified from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database. The 9442 patients identified were randomly divided into training and testing cohorts. Univariate and multivariable logistic regression were performed; variables significantly associated with complications were evaluated using the Akaike information criterion and area under the curve. Significant variables received weighted scores, and a patient-specific prediction model was generated and evaluated using the Brier score.ResultsPatients with central nervous system abnormality (OR 1.32 [95%CI 1.13-1.53]), hematologic disorder (OR 1.40 [1.06-1.85]), congenital malformation (OR 1.30 [1.1-1.54]), nutritional support (OR 2.21 [1.91-2.57]), and preoperative wound infection (OR 2.3 [1.4-3.76]) were more likely to develop complications after spinal fusion surgery. PV-5 scores were calculated from these risk factors to generate a prediction model. PV-5 scores of 1 (OR: 2.0 [1.27-3.43], P < 0.004), 2 (OR: 2.75 [1.63-4.64], P < 0.001), 3 (OR: 3.67 [2.18-6.19], P < 0.001), 4 (OR: 4.09 [2.39-6.99], P < 0.001), and 5+ (OR: 3.58 [1.35-9.47], P = 0.01) predicted greater complication risk than PV-5 of zero (accuracy = 89.65%, Brier score = 0.09).ConclusionsUsing factors associated with complications in children with NMS undergoing spinal fusion surgery, we created a prediction model to illustrate physiologic vulnerability and morbidity. Our model serves as a foundation for further body system-specific investigation.

Frailty in the elderly population is associated with increased vulnerability to stressors, including surgical interventions. This study compared machine learning (ML) models with a clinical bedside tool, the Gastrointestinal Surgery Frailty Index (GiS-FI), for predicting mortality and morbidity in elderly patients undergoing gastrointestinal cancer surgery. In a multicenter analysis of 937 patients aged ≥65 years, the performance of various predictive models including Random Forest (RF), Least Absolute Shrinkage and Selection Operator (LASSO), Stepwise Regression, K-Nearest Neighbors, Neural Network, and Support Vector Machine algorithms were evaluated. The overall 30-day mortality and morbidity rates were 6.1% and 35.7%, respectively. For mortality prediction, the RF model demonstrated superior performance with an AUC of 0.822 (95% CI 0.714-0.931), outperforming the GiS-FI score (AUC = 0.772, 95% CI 0.675-0.868). For morbidity prediction, all models showed more modest discrimination, with stepwise regression and LASSO regression achieving the highest performance (AUCs of 0.652 and 0.647, respectively). Our findings suggest that ML approaches, particularly RF algorithm, offer enhanced predictive accuracy compared to traditional clinical scores for mortality risk assessment in elderly cancer patients undergoing gastrointestinal surgery. These advanced analytical tools could provide valuable decision support for surgical risk stratification in this vulnerable population.

Frailty indices have emerged as robust predictors of morbidity and mortality following neurosurgical interventions. However, their impact on long-term functional and cognitive outcomes remains insufficiently characterised. This study evaluated the prognostic significance of frailty in patients undergoing emergency neurosurgical care and subsequent neurorehabilitation. Based on a cumulative deficit model, a validated 34-item Frailty Index (FI) was applied retrospectively to patients admitted for acute neurosurgical care at a tertiary academic centre and transferred to a specialised neurological rehabilitation facility. Perioperative clinical data, postoperative complications, and discharge dispositions were analysed. A total of 236 patients (median age: 64 years) were included, with 75 (31.8%) classified as "Fit," 87 (36.9%) as "Semi-fit," and 74 (31.4%) as "Frail." Only 13 (17.6%) frail patients returned home post-rehabilitation, compared to 64 (85.3%) fit and 61 (70.1%) semi-fit patients (p = 0.0006). Multivariable logistic regression confirmed FI as an independent predictor of unfavourable discharge destinations (hospital or nursing home vs. home; adjusted odds ratio: 3.615, 95% CI: 1.655-5.580; p = 0.0094). Frailty significantly influences postoperative recovery, predicting greater disability, lower neurological and cognitive function, and unfavourable discharge outcomes. Incorporating frailty assessment into routine emergency practice and research protocols may refine risk stratification and inform clinical decision-making for acutely ill patients undergoing neurosurgical interventions.

To assess the predictive value of frailty measured by the timed up and go (TUG) test on perioperative outcomes versus other perioperative screening methods DESIGN: Retrospective cohort study SETTING: Duke University Hospital and Duke Raleigh Hospital PATIENTS: Patients who underwent surgery with gynecologic oncologists at our institution from October 2019-October 2023 with a preoperative TUG time recorded were included.

TUG times were recorded preoperatively. TUG time >12 seconds was considered frail. American Society of Anesthesiologists (ASA) scores were extracted from the medical record. Modified frailty index (mFI) was calculated using 11 variables extracted from the medical record.

Outcomes included postoperative complications, length of stay, and postoperative disposition. Comparisons between TUG times dichotomized at 8 and 12 seconds were made using Wilcoxon rank sum or chi-square; logistic regression was used to predict TUG time using these dichotomizations. Overall, 174 patients were included; 39 (22.4%) underwent laparotomy, 123 (70.6%) underwent laparoscopy, and 12 (6.9%) underwent other minor surgeries. Frail patients (TUG time > 12 seconds) were older, had higher mFI scores and lower preoperative albumin than non-frail patients. There were no differences in major or minor complication rates after laparoscopic surgery between frail and non-frail patients. ASA and mFI were not associated with need for transfusion (p>0.05). Frail patients were more likely to receive a perioperative blood transfusion compared to non-frail patients in the overall cohort (19.2% vs 4.1%, p=0.0034). TUG time did not predict length of stay or postoperative disposition.

Slower TUG times were associated with comorbidities, older age, and malnutrition. Frailty was not associated with complications in those who underwent laparoscopic surgery. Our findings support the use of this easy to administer practical frailty screening tool compared to more traditional methods.

Same-day mastectomy is safe and high value. However, patients ≥ 65 years are less likely to be discharged compared with younger patients. Our aim was to implement a protocol to increase the rate of elderly same-day discharge.

Patients were screened by 5-factor modified frailty index and notification of frailty status was sent to surgeons. Patients with moderate-to-high frailty were encouraged to have prehabilitation. Chart review collected demographic/clinicopathologic variables, length of stay, and complications. The primary endpoint was same-day discharge, and sample size determination was 50 patients. Our discharge rate was compared with our historic rate (18.8% March 2022 to February 2023) by Fisher's exact test.

From March 2023 to January 2024, 306 patients aged ≥ 65 years were screened. Overall, 55 patients underwent a total of 57 mastectomies (18.6%). Median age was 72 years (range: 65-99). Frailty scores ranged from 0 to 4. In total, 11 patients (19.3%) had a score of zero, 41 (71.9%) scored 1 or 2, and 5 patients (8.8%) scored 3 or 4. Seven patients were referred to geriatric oncology for prehabilitation: one non-frail, four with low frailty, and two with moderate frailty. The median length of stay (LOS) was 0 days (range: 0-21). Thirty-two mastectomies had same-day discharge (56.1%), significantly higher than historic data (P < 0.00001).

We increased same-day discharges for patients ≥ 65 years from 18.8% to 56.1%. This protocol included a simple frailty screening and a weekly email. Future directions include increasing the proportion of patients who receive geriatric oncology prehabilitation referrals and evaluating patient-reported outcomes.

Head and neck cancer (HNC) significantly impacts older adults, with mortality influenced by multiple factors. The Multidimensional Prognostic Index (MPI), derived from comprehensive geriatric assessment (CGA), may improve risk stratification and clinical decision making.

An observational cohort study was conducted at Erasmus Medical Center, Rotterdam, from December 2019 to June 2021. We included 423 HNC patients aged 70 years or older or younger patients with a G8 score of 14 or less. MPI stages were determined through CGA, categorized into stages 1, 2, and 3.

During a median follow-up of 595 days, 115 patients (29%) died. MPI stage 2 and stage 3 were associated with a higher mortality risk compared to MPI stage 1 (HR 2.18; 95% CI 1.46-3.26). In the surgical subgroup, similar mortality risks were observed, but MPI stages did not correlate with postoperative complications.

MPI stages derived from CGA effectively predict mortality risk in older HNC patients, though they do not predict postoperative complications.

Background/Objectives: Nonacute subdural hematomas (naSDHs) are a prevalent intracranial pathology, particularly in older people, due to increased brain atrophy, fall risk, and anticoagulant use. This study examines the impact of frailty on the surgical outcomes of craniotomy for naSDH over 20 years. Methods: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2021 were analyzed, including 251,597 patients who underwent cranial decompression for naSDH. Patients were selected using specific ICD codes. Frailty was calculated using the modified frailty index (mFI-5 and mFI-11) and the Charlson Comorbidity Index (CCI). Outcomes were compared using descriptive statistics and multivariable regression models. Results: 251,597 patients underwent craniotomy, with a mean age of 69.2 years. The cohort exhibited significant comorbid conditions, reflected in a mean Charlson Comorbidity Index (CCI) of 3.8, and a high frailty prevalence, with 23.49% of patients classified as frail and 20.14% as severely frail. The CCI demonstrated the highest predictive value for adverse outcomes, with an area under the curve (AUC) of 0.6346 for mortality and 0.6804 for complications. Frailty indices (mFI-5 and mFI-11) were also strongly associated with increased mortality (p < 0.001), complications (p < 0.001), and extended length of stay (p < 0.001). Age was not a significant predictor of outcomes. Conclusions: This study highlights the moderate impact of frailty on surgical outcomes for naSDH.

Frailty describes a geriatric syndrome characterized by an increased vulnerability. Although a variety of potential blood-based biomarkers have been discussed for its characterization, a reliable protocol considering blood-based biomarkers for this purpose is still missing. However, a comprehensive overview on these biomarkers is necessary to understand potential molecular pathways to frailty. We, therefore, performed a mapping review to identify those blood-based biomarkers most consistently associated with frailty in community-dwelling older adults as well as possible analytical gaps according to the available literature. A proposed weighted correlation index (CI) describing the direction and consistency of the association considering the number of available publications as well as the size of the study populations was calculated for each biomarker. Overall, 72 manuscripts were critically reviewed reporting on a total of 82 biomarkers. The most consistent positive association with at least 3 articles addressing the respective biomarker in unadjusted and fully adjusted models was shown for interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), neopterin, white blood cells count, glycated hemoglobin A1c (HbA1c) and sex hormone binding-globuline (SHBG) with a CI ≥ 0.7, while for negative association hemoglobin, 25-hydroxy vitamin D, free testosterone in men and albumin with a CI ≤ -0.7 were identified.

To compare differences in pain, depression, function, and informal caregiving pre-major and post-major elective surgery among older adults with and without serious illness; and determine whether serious illness was independently associated with increasing pain, depression, assistance in activities of daily living (ADLs) and informal caregiving postsurgery.

The American College of Surgeons has endorsed the integration of palliative care (PC) into surgical care in adults with serious illness but targets for PC during surgical episodes such as pain, depression, function, and informal caregiving are understudied.

We used Health and Retirement Study-linked Medicare data (2008 to 2018) to identify older (≥66 years) adults with and without serious illness who had major elective surgery. We performed difference-in-difference analysis to measure changes in pain, depression, function, and informal caregiving presurgery and postsurgery between groups. We tested associations between serious illness and changes in pain, depression, function, and informal caregiving using multivariable regression.

Among 1896 adults who had major surgery, 1139 (60%) were seriously ill. Compared with adults without serious illness, those with serious illness had greater baseline pain (43% vs 38%), depression (22% vs 13%), assistance with ADLs (12% vs 0%,) and informal caregiving (18% vs 4%); and, greater increases in assistance with ADLs presurgery and postsurgery (difference-in-difference: 6%, 95% CI: 3.7 to 8.3). Serious illness was independently associated with increasing pain [odds ratio (OR): 1.6, 95% CI: 1.1 to 2.2], depression (OR: 1.5, 95% CI: 1.1 to 2.2), assistance with ADLs (OR: 2.1, 95% CI: 1.3 to 3.4), and informal caregiving (OR: 2.1, 95% CI: 1.4 to 3.1) postsurgery.

Most older adults having elective surgery are seriously ill. Pain, depression, function, and caregiving are targets for PC to improve post-surgical outcomes.

Enhanced Recovery After Surgery (ERAS) clinical pathways have demonstrated improved perioperative outcomes after major surgery. However, its adoption within vascular surgery has been limited. In this study, we examined the impact of an ERAS protocol with multimodal anesthesia on open abdominal aortic aneurysm (AAA) repair by comparing early outcomes before and after its implementation.

This retrospective study analyzed early outcomes after elective open repairs of intact AAA performed from 2013 to 2023 at a single institution. Eighty consecutive patients treated after implementation of an ERAS protocol with multimodal anesthesia were compared with 161 patients treated before its implementation. Propensity score matching based on age, gender, body mass index, Vascular Quality Initiative AAA Mortality Risk Score, Rockwood Frailty Scale, aortic cross clamp location, aneurysm size, and type of exposure was performed to achieve one:one matching using the nearest neighbor technique. Quantile and logistic regression assessed the impact of the ERAS protocol on length of stay, 30-day mortality, opioid consumption (morphine milligram equivalents), hospital cost, complications, and readmissions.

Both groups (ERAS vs pre-ERAS, respectively) were predominantly male (80% vs 73%; P = .27), with a median age of 74 years. Similar mean Vascular Quality Initiative predicted mortality (2.9% vs 4.0%; P = .13), clinical frailty score (3.1 vs 3.3; P = .17), aneurysm size (60 mm vs 62 mm; P = .06), rates of suprarenal cross-clamp (76% vs 88%; P = .07), chronic obstructive pulmonary disease (29% vs 31%; P = .73), chronic kidney disease (14% vs 16%; P = .66), myocardial disease (16% vs 20%; P = .54), and cerebrovascular disease (15% vs 19%; P = .53) were observed in the matched groups. ERAS was associated with a reduction in length of stay by 3 days (P < .001), a decrease in opioid consumption by 37 morphine milligram equivalents (P < .001), and a reduction in hospital costs by US$4704 (P < .001). There was a trend toward a lower risk of major complications (odds ratio, 0.44; 95% confidence interval, 0.2-1.1; P = .06). Thirty-day mortality (5% vs 6.3%; P = .73) and readmission (7.9% vs 13.2%; P = .29) rates were similar in both groups.

An ERAS protocol using a multimodal anesthesia was associated with improved early outcomes compared with patients treated before ERAS implementation. These results mirror similar benefits seen in nonvascular ERAS programs, and broader application should be considered in institutions that perform a high volume of open aortic repairs.

Bariatric surgery is an effective treatment for obesity and its associated comorbidities. However, the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for elderly and frail populations remain uncertain.

To validate the efficacy and safety of LSG for elderly and frail patients and to assess its impact on overweight and obesity-related comorbidities.

A retrospective cohort study of patients undergoing LSG at a university-affiliated single center between 2009 and 2022 from a prospectively maintained database. Patients were categorized into two cohorts based on age and frailty index: elderly vs younger patients and frail vs non-frail groups. Preoperative, perioperative, and postoperative data were analyzed.

Frailty was associated with statistically significantly higher perioperative complications (%, Clavien-Dindo of III/IV, 8 vs 3) and lower treatment success rates (% Excess Body Weight Loss, six-month, year, and two-year, 58 vs 64, 73 vs 82, 72 vs 81, and 63 vs 76, respectively). Age was not shown to alter the safety or efficacy of the operation.

While LSG is a viable option for elderly and frail patients, frailty is a significant predictor of treatment outcomes. A comprehensive assessment of individual factors, including frailty status, is essential for informed decision-making before surgery.

Introduction: Frailty is increasingly recognized as a critical predictor of adverse outcomes in older adults, particularly those with cancer. However, the role of frailty-distinct from comorbidity burden-has not been fully characterized in older adults hospitalized with cholangiocarcinoma (CCA), a rare but aggressive malignancy with rising incidence in the aging population. Methodology: A retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) 2019-2022 was performed. Adult inpatients aged ≥ 65 with CCA-related ICD-10 codes were identified. Patients were stratified into frailty categories based on the Hospital Frailty Risk Score (HFRS). Multivariable regression models were used to assess associations with in-hospital mortality, length of stay (LOS), and hospital charges. Results: Among 18,785 hospitalizations, the in-hospital mortality rate was 7.18%. High frailty conferred an eight-fold increased risk of mortality, a 70% longer LOS, and 52% higher charges compared to low frailty. Elixhauser comorbidity scores were not significantly associated with outcomes. Discussion: These findings support the use of frailty screening to guide inpatient care planning and optimize outcomes in older adults with CCA.

Frailty is a heightened vulnerability to stress due to decreased physical and mental abilities. Preoperative frailty has been associated with poorer outcomes. However, frailty is not static, and those patients who eventually die appear to become more frail. Our hypothesis is in-patient, postoperative changes in frailty after major operations predicts the trajectory to postoperative discharge alive or in-hospital mortality.

The accumulating deficit model of frailty was used. Data from the medical records of patients who have undergone major operations were used to determine the mFI preoperatively, postoperative day 1, and day before discharge or death. Of the 1063 patients who met inclusion criteria, 50 patients with in-hospital postoperative death and 50 patients discharged alive were randomly selected.

Patients in the in-hospital mortality group had significantly greater median preoperative mFI scores than those in the discharged alive (0.178 vs. 0.115 p = 0.00009). This significant difference was present on postoperative day 1, while also increasing in margin (0.240 vs. 0.143, p < 0.00001). Median Pre-Post mFI differences were also significant between the two groups, with operations leading to in-hospital mortality experiencing a greater increase in mFI (0.06 vs. 0.01 p = 0.00019), and the day before death or discharge (0.276 vs. 0.014, p < 0.00001).

Preoperative mFI is a useful predictor of postoperative mortality. Moreover, worsening mFI score as early as day 1 and continued worsening scores throughout hospitalization are associated with a postoperative trajectory toward mortality. Recognition of worsening frailty may be helpful in identifying patients in need of early intervention.

This article provides an in-depth review of cerebrospinal fluid (CSF) shunts for managing hydrocephalus and idiopathic intracranial hypertension, with a focus on advanced surgical techniques and strategies to prevent complications. It examines the placement of ventricular, lumbar, peritoneal, atrial, and pleural catheters, highlighting the benefits of neuro-navigation, endoscopic visualization, and laparoscopic-assisted approaches. Evidence-based methods to reduce shunt infections, malfunctions, and overdrainage are discussed, along with a comparative analysis of shunt types tailored to individual patient needs. The article also explores innovations such as programmable valves, antimicrobial coatings, and transesophageal echocardiography, offering insights into future directions for optimizing CSF shunting outcomes.

Frailty is characterized by decreased physiological reserve and vulnerability to adverse events in the presence of a stressor such as surgery. We prospectively implemented a preoperative frailty screening and optimization pathway for patients undergoing vascular surgery and assessed its impact on postoperative outcomes.

As part of an ongoing quality improvement initiative, surgical frailty was assessed prospectively in all patients undergoing inpatient surgery using the Risk Analysis Index (RAI). Baseline data were collected from May to July 2022. Frail patients (RAI score of ≥37) were referred to an anesthesia optimization clinic, nutrition consultation, and case management evaluation in the intervention phase (August 2022 to July 2023). Primary outcomes were postoperative hospital length of stay, 30-day readmission, and 30-day mortality. Secondary outcomes included intensive care unit (ICU) admission, ICU length of stay, discharge disposition, and nonhome discharge. Two-way analyses compared frail vs nonfrail patients and preintervention vs postintervention groups using the Student t test or Wilcoxon rank-sum test for continuous variables and the χ2 or Fisher's exact test for categorical outcomes.

Of all patients scheduled for elective inpatient vascular surgery procedures at a single institution (n = 225), 216 completed frailty screening (mean age, 72 years; 68.5% male; 54.6% White; mean RAI, 28.9; 18.5% frail). Of these, 15 had surgeries cancelled, and 201 ultimately underwent surgery with 36 (17.9%) identified as frail. Overall, frail patients had significantly longer ICU (median, 4.0 days [intertquartile range (IQR), 2.5-13.5 days] vs median, 2.0 days [IQR, 1-4 days]; P = .001) and hospital length of stay (median, 2.45 days [IQR, 1.51-5.67 days] vs median, 1.23 days [IQR, 1.0-2.1 days]; P = .001), higher nonhome discharge (30.6% vs 4.2%; P < .0001), and higher 30-day readmission (22.2% vs 6.7%; P = .009) compared with nonfrail patients. Comparing preintervention and postintervention groups, the 30-day readmission rates for the overall cohort decreased significantly (from 22.2% to 7.5%; P = .03). Among frail patients, there was a trend toward a reduced hospital length of stay (from 4.73 to 2.14 days), nonhome discharge (from 57.1% to 24.1%), and 30-day readmission (from 42.9% to 17.2%); however, these differences did not reach statistical significance. Overall, the 30-day mortality rate was 1.5% with all three deaths (two frail, one nonfrail) occurring during the postintervention period (0% pre vs 1.7% post; P = 1.0).

Successful implementation of a preoperative frailty screening and optimization pathway for patients undergoing elective vascular surgery led to a significant decrease in overall 30-day readmission and a trend toward reduced hospital length of stay, nonhome discharge, and 30-day readmission for frail patients. Further expansion to all surgical clinics has the potential to improve quality metrics for the health care system.

How to cite this article: Ganesh KM, Krishna B. Utility of Clinical Frailty Scale in Intensive Care Unit. Indian J Crit Care Med 2025;29(4):289-290.

The modified 5-item frailty index (mFI-5), an index of reduced physiological reserve, has risen as a predictor of complications following surgical procedures. We examined the association of mFI-5 and surgical outcomes following the management of nontraumatic subarachnoid hemorrhage (nSAH). We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients who received surgical management of nSAH between 2006 and 2021. We computed the mFI-5 by granting a point for each of 1) congestive heart failure, 2) hypertension requiring medications, 3) diabetes, 4) chronic obstructive pulmonary disease or pneumonia within 30 days before surgery, and 5) dependent functional status. Our 30-day endpoints were minor complications (Clavien-Dindo: 1 & 2), major complications (Clavien-Dindo: 3 & 4), and mortality. Using the Chi-squared test, we compared baseline patient demographics and comorbidities between patients with a mFI-5 ≥ 2, patients with a mFI-5 = 1, and non-frail patients. Then, we fitted a multivariable logistic regression adjusting for patient demographics, comorbidities, operative time, and frailty status. The cohort included 1,139 patients, of which 33.7 % were men and 2.9 % had a bleeding diathesis. After adjusting for covariates, mFI-5 ≥ 2 was independently associated with minor complications (1.93, 95 %CI: 1.31-2.84, p = 0.001), major complications (aOR: 1.62, 95 %CI: 1.10-2.37, p = 0.015), and mortality (aOR: 2.90, 95 %CI: 1.66-5.08, p = 0.003). The mFI-5 can be independently used by surgeons for risk stratification and postoperative planning.

The number of elderly patients with degenerative spinal deformity (DSD) is increasing, and posterior thoracolumbar fusion surgery is an effective treatment option, but there are often postoperative major complications, which may hinder the benefit for elderly patients. Currently, there is no consensus on the best risk assessment technique for predicting major complications in elderly patients undergoing long-segment fusion surgery.

This study constructs a risk assessment model using the Modified 5-Item Frailty Index (mFI-5) and serum albumin and evaluates its predictive value.

This is a retrospective analysis of a prospectively established database of DSD.

Consecutive patients (aged 65 and older) who underwent open posterior thoracolumbar fusion surgery for DSD between April 2018 and December 2023 were included.

Outcome measures included postoperative major complications, length of hospital stay (LOS), readmission and reoperation within 30 days, discharge disposition, physiological function recovery.

The study reviewed consecutive patients who underwent open posterior thoracolumbar fusion surgery for DSD. Patients were divided into three groups based on the presence or absence of frailty or frailty combined with malnutrition. Spearman ρ analysis was used to assess the correlation between mFI-5 and serum albumin levels. Univariate analyses and multivariate logistic regression were conducted to explore the relationship between frailty and malnutrition defined by mFI-5 and serum albumin and major postoperative complications. Finally, the Receiver Operating Characteristic (ROC) curve was used to evaluate the predictive value of this model for major complications.

Compared to the Normal group (n=59), both the Frailty group (n=121) and the Frailty and Malnutrition group (n=50) had higher rates of major complications (21.5% vs 8.5%, p=.035; 28% vs 8.5%, p=.002). Multivariate logistic regression showed that frailty and malnutrition status, higher ASA score, and more bleeding were independent predictors of major postoperative complications. The ROC curve demonstrated that frailty combined with malnutrition defined by mFI-5 and serum albumin had a larger area under the curve compared to mFI-5 or serum albumin alone (AUC: 0.676; 95% CI: 1.101-14.129; p<.001).

Compared to considering frailty or malnutrition alone, the combined assessment of frailty and malnutrition using mFI-5 and serum albumin is valuable in predicting major complications in elderly patients undergoing posterior thoracolumbar fusion surgery.

Frailty has emerged as a critical predictor of postoperative outcomes, particularly in older surgical patients. However, its role in mastectomy patients remains underexplored. This study evaluates the utility of the 5-item Modified Frailty Index (mFI-5) in predicting 30-day postoperative complications in mastectomy patients, aiming to improve risk stratification and inform clinical decision-making.

A retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted from 2008 to 2022. Patients were categorized into high-risk (mFI-5 ≥ 2) and low-risk (mFI-5 < 2) groups. Propensity score matching (PSM) was applied to create balanced cohorts and multivariate logistic regression was used to evaluate associations between frailty and postoperative outcomes.

Of the 252,054 adult female patients who underwent mastectomy, 1.2 % were identified as high-risk frail. High-risk patients were older (70 ± 9.9 vs. 60 ± 14 years, P < .001) and had a higher BMI (35 ± 9.1 vs. 29 ± 7.1 kg/m², P < .001) compared to low-risk patients. After PSM, high-risk patients had significantly higher odds of any complication (OR: 2.05, 95 % CI: 1.70-2.47, P < .001), surgical complications (OR: 1.70, 95 % CI: 1.38-2.10, P < .001), and medical complications (OR: 3.81, 95 % CI: 2.64-5.50, P < .001). Key complications included infections, bleeding requiring transfusion, and unplanned readmissions.

The mFI-5 effectively identifies mastectomy patients at higher risk of postoperative complications, including medical complications and unplanned reoperation or readmission, underscoring its value in preoperative risk stratification. Incorporating frailty assessments into clinical practice could enhance surgical decision-making, optimize resource allocation, and improve patient outcomes.

Frailty is common among older patients; however, there is a lack of agreement on methods to diagnose and monitor frailty at point of care. The purpose of this study was to establish consensus on important, feasible, and usable domains for point-of-care frailty assessment within all conceptual models of frailty.

We reviewed instruments that assess frailty and extracted the domains measured by each tool. We developed 3 use cases for frailty assessment, which provided context for voters: (1) longitudinal tracking of frailty in the aging patient (>50 years), (2) preoperative evaluation of frailty before surgery in adults (>50 years), and (3) discharge disposition after hospital admission in adults (>50 years). We conducted a modified RAND Corporation/University of California Los Angeles Delphi with a panel of 11 experts. Panelists rated each domain for each use case on a scale from 1 to 9, where 1 is definitely not important/feasible/usable and 9 is definitely important/feasible/usable.

Panelists achieved agreement on the following domains for the respective clinical use cases: Physical Strength 1, 2, and 3; Balance 1 and 3; Cognition 1, 2, and 3; Nutrition 1; Physical Activity 1, 2, and 3; Depression 1; Disease 1, 2, and 3; and Social Environment 1 and 3. The remaining items were indeterminate.

We established consensus on 8 domains of frailty across 3 use cases. These results can inform the measurement of domains to diagnose, monitor, and inform the management of frailty within the defined use cases.

Palliative care includes effective communication, relief of suffering and symptom management with an underlying goal of improving the quality of life for patients with serious illness and their families. Best practice palliative care is delivered in parallel with life-sustaining or life-prolonging care. Palliative care affirms life and regards death as a normal process, intends neither to hasten death nor to postpone death and includes but is not limited to end-of-life care. Palliative care encompasses both primary palliative care (which can and should be incorporated into the practice of acute care surgery) and specialty palliative care (consultation with a fellowship-trained palliative care provider). Acute care surgeons routinely care for individuals who may benefit from palliative care. Patients exposed to traumatic injury, emergency surgical conditions, major burns and/or critical surgical illness are more likely to be experiencing a serious illness than other hospitalized patients. Palliative care research is urgently needed in acute care surgery. At present, minimal high-quality research is available to guide selection of palliative care interventions. This narrative review summarizes the current state of research challenges and opportunities to address palliative care in acute care surgery. Palliative care research in acute care surgery can rely on either primary data collection or secondary and administrative data. Each approach has its advantages and limitations, which we will review in this article.

As the population ages, the number of total joint arthroplasty (TJA) performed is rising, making early identification of patients at risk for adverse events essential to improving care and reducing healthcare costs. The aim of this study was to evaluate the association between Clinical Frailty Scale (CFS) and postoperative outcomes in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

We conducted a retrospective study of prospectively collected data regarding 328 TKAs and 294 THAs at a single institution from February 2019 to February 2020. Patient demographic data were harvested, and the preoperative CFS scores were calculated for all patients and analyzed to identify their associations with the length of stay (LOS), the need for admission to an inpatient rehabilitation unit (IPRU), postoperative complications and patient-reported outcome measures (PROMs).

Robust patients (CFS < 3) had a significantly shorter LOS than their non-robust (CFS > 3) counterparts in both the TKA and THA groups (3.7 vs. 5.2 days, P < 0.001, and 3.8 vs. 5.8 days, P < 0.001, respectively). IPRU admission rates were significantly higher in non-robust than in robust patients. Specifically, none of the robust TKA patients required IPRU admission, whereas up to 39 non-robust patients (11.9%) did (P < 0.001). Similarly, for THA, 9 robust (5.7%) and 30 non-robust (21.9%) patients were admitted to an IPRU (P < 0.001). Non-robust patients had a significantly higher complication rate for both THA (11.0% vs. 6.4%, P = 0.03) and TKA (8.7% vs. 2.6%, P = 0.11). Both cohorts showed significant improvements in PROMs post-surgery, with non-robust patients experiencing greater relative gains than robust patients.

CFS is a strong predictor of the hospital length of stay, IPRU admission, and complication rates following TJA. This study also highlighted the link between frailty and PROMs in joint replacement patients. The CFS may be a valuable tool in the preoperative assessment of elective THA and TKA.

The Surgical Pause is a rapid, scalable strategy for health care systems to optimize perioperative outcomes for high-risk, frail patients considering elective surgery. The first and most important step is to screen for frailty, thereby identifying the 5% to 10% of patients at most risk for postoperative complications, loss of independence, institutionalization, and mortality. The second step is to take action to improve outcomes. Action may include clarifying perioperative goals, optimizing perioperative decision-making, and mitigating frailty-associated risks through prehabilitation.

Initially implemented at the Omaha Veterans Affairs (VA) Medical Center in 2012, the Surgical Pause was associated with a nearly three-fold survival advantage among the frail. The program was subsequently replicated at more than 50 VA and private sector hospitals with similarly robust results, leading the Veterans Health Administration (VHA) National Surgery Office to formally adopt the program in January 2024. The Joint Commission and the National Quality Forum recognized the program with the Eisenberg Award for Patient Safety and Quality at the National Level.

Successful dissemination grew from simultaneous real-world quality projects paralleled by rigorous, high-quality, peer reviewed publications demonstrating the need for and impact of the Surgical Pause. Adoption was facilitated in an iterative process to streamline feasibility and leverage existing resources. Success was accelerated by national infrastructure catalyzing a community of practice.

The Surgical Pause is changing surgical culture by proactively identifying frail patients, aligning treatment plans with patient-defined goals, optimizing perioperative decisions, and mitigating frailty-associated risks to deliver both quality and value.

To develop a surgical risk calculator for older adults undergoing suprapubic tube (SPT) placement that specifically factors in frailty, a key predictor of surgical risk in this vulnerable and heterogenous population.

Medicare MedPAR, Outpatient, and Carrier files for beneficiaries undergoing SPT placement between 2014-2016 were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty, was used to calculate baseline frailty for each beneficiary. Stepwise regression models were used for each variable within the CFI and Charlson Comorbidity Index to determine the variables most highly predictive of postoperative complications. The most highly predictive variables were then combined into parsimonious categories. To ensure the prognostic accuracy for each outcome, calibration curves and tests of model fit, including C-statistics, Brier scores, and Spiegelhalter P-values were calculated.

A total of 26,999 beneficiaries were included. Among these, 39.1% were pre-frail, 36.8% were mildly frail, and 12.3% were moderately to severely frail. Thirteen prognostic variable categories were deemed highly predictive of postoperative complications of interest. All models demonstrated low Brier scores, indicating high model accuracy, and high C-statistic and Spiegelhalter P-values, consistent with excellent model discrimination and calibration, respectively. Excellent model fit was seen on calibration curves for each outcome.

UroARC is a novel surgical tool for older adults undergoing SPT placement that specifically factors in frailty. This risk calculator has high accuracy, calibration, and discrimination, and serves as a valuable resource to patients and clinicians for those undergoing consideration for SPT placement.

The Risk Analysis Index (RAI) has emerged as the most thoroughly validated and flexible assessment of surgical frailty, proven feasible for at-scale bedside screening and available in a suite of tools, that effectively risk stratifies patients across a wide variety of clinical contexts and data sources. This user guide provides a definitive summary of the RAI's theoretical model, historical development, validation, statistical performance, and clinical interpretation, placing the RAI in context with other frailty assessments and emphasizing some of its advantages. Detailed instructions are provided for each RAI variant, along with a systematic review of existing RAI-related literature.

Colorectal cancer is a leading cause of cancer mortality in the USA and occurs most frequently in older adults. These patients are at increased risk of adverse outcomes following major cancer surgery. While prehabilitation has been shown to mitigate this risk, multiple barriers to implementation remain. Our team created a digital tool co-designed with older adults that employs an algorithm to assess patient-specific geriatric vulnerabilities and generate personalised prehabilitation programmes before surgery.

We have designed a multisite, unblinded randomised trial to be completed at three high-volume academic cancer centres located in California or Texas. Our study population is individuals aged 65 and older with planned colorectal cancer resection who are proficient in English and have home internet access. We aim to enroll 132 patients who will be randomised in a 2:1 ratio to receive the intervention (assistance from a home health coach and access to the web application (web app)) or control (usual care with written prehabilitation materials). Our primary outcome is patient engagement with prehabilitation activities.

A properly executed, written, informed consent will be obtained from each subject prior to entering the subject into the trial. Information will be given in both oral and written form, and subjects may withdraw at any time from the study without effect on their medical care. The protocol and consent form have been approved by the Institutional Review Board (IRB) of each participating centre. We anticipate publication of results in a peer-reviewed journal.

NCT05520866.

A predictive index for surgical complications in pediatric patients is lacking in the current scientific literature. We have developed a simple index to accurately predict the likelihood of complications after surgery. The Surgical Complication Index for Pediatric Patients (SCIPP) is reliable and accurate for both heterogenous and specific groups of pediatric patients.

A retrospective analysis of pediatric neurosurgical procedures from 2005 to 2023 was conducted. Logistic and linear regression analyses were performed to analyze the correlation with their respective SCIPP scores and post-operative complications and length of stay (LOS).

Our cohort included 90 tethered cord patients and 43 surgeries consisting of craniotomies/craniectomies, laminectomies/laminotomies, and others. The mean SCIPP score across all 133 patients was 2.41 ± 1.76, with an average age of 5.37 ± 5.53 years. From the logistic regression, each 1-point increase in SCIPP score was associated with increased odds of experiencing a complication after surgery in all patients (odds ratio: 1.57; p < 0.001) and tethered cord patients (odds ratio: 1.59; p = 0.007). The reduced 4-point SCIPP was associated with increased odds in all patients (odds ratio: 2.67; p < 0.001) and tethered cord patients (odds ratio: 2.89; p = 0.001) as well. Upon linear regression analysis, each 1-point increase in SCIPP was associated with a 0.49 day increase in LOS (p = 0.002). Each 1-point increase in reduced SCIPP was associated with a 0.42 day increase in LOS but was not statistically significant (p = 0.120).

The SCIPP is a simple and accurate tool that predicts surgical complications and LOS in a variety of pediatric neurosurgical procedures and can be used to counsel patients and families on the risks of surgery.

In the landscape of knee-related health issues there has been a notable shift in treatment protocols. Nowadays, there is a growing trend toward primary total knee arthroplasty (TKA) in the event of periarticular knee fractures. A review of the literature on TKA in acute knee fractures has been done in order to provide scientific evidence to the four statements submitted for voting to the members of the European Knee Society (EKS).

A literature review has been performed around four topics of TKA in acute knee fractures, specifically: 1) The indications for TKA in acute knee fractures are undoubtful and clear; 2) Pre-existing osteoarthritis is not mandatory for the indication of TKA in acute fractures, while age, co-morbidities and type of fracture are; 3) A series of established criteria with scores to give indication for TKA (approved algorithm) is needed; and 4) This (complex) surgery must be performed in referral centers with all technical options and specific peri-operative management and post-operative care.

The panel of experts therefore believes that the indications cannot be considered undoubtful and clear. According to the literature up to the time of the consensus vote, there was no objective method for deciding on the treatment to offer the patient (Agree: 34.1%, Disagree: 61%, Abstain: 4.9%). It emerges that there are no mandatory conditions for the treatment of acute knee fractures with TKA (Agree: 32.3%, Disagree: 51.6%, Abstain: 16.1%). However, there are several characteristics to consider for a multifactorial evaluation rather than being limited to a single condition. While the consensus has highlighted a need for a scoring system to guide surgical decisions in periarticular knee fractures (Agree: 88.24%, Disagree: 8.82%, Abstain: 2.94%), research in the literature has confirmed that, to date, no validated algorithm exists. After the vote, a score was proposed, which requires validation. Although the panel of experts does not deem it necessary for this surgery to be reserved for reference centers (Agree: 32.35%, Disagree: 50%, Abstain: 17.65%), literature suggests that it is crucial that before undertaking knee arthroplasty in the setting of an acute fracture around the knee, the orthopedic surgeon is confident with all the necessary skills for a complex intervention that requires advanced knowledge and practical competence in osteosynthesis and revision TKA.

This discussion on the questions voted by the panel of experts has allowed for an in-depth exploration of a topic of interest, assessing indications, contraindications, types of possible treatment, and the critical aspects to consider when treating an acute fracture around the knee with a prosthesis. It is important to consider that the choice must be carefully weighed, evaluating the risks and benefits, with an increasingly need for a scoring system for selecting the most appropriate treatment.

The estimated incidence of chronic subdural hematomas (cSDH) in the general population is projected to nearly double over the next decade, likely making it the most commonly treated cranial neurosurgical condition in adults by 2030. We investigated the outcomes of middle meningeal artery embolization (MMAe) as either a primary or adjunctive treatment for cSDH in nonagenarian patients.

We retrospectively reviewed all patients 90 years of age or older treated with middle meningeal artery embolization for cSDH from 2018 to 2024 at two academic institutions. Statistical analysis was performed on patient demographics, baseline functional status, intervention, cSDH size, recurrence rate, reintervention rate, and follow-up functional status.

Twenty-one patients aged 90 or older were identified who were treated with MMAe for cSDH. Hematoma thickness ranged from 10mm to 34mm with a mean midline shift of 4.6mm. Eighteen patients were treated with MMAe alone, while three patients underwent surgery followed by MMAe. A total of 20 patients had radiological follow up, with no evidence of growth or recurrence in 95 % of the patients. There was one recurrent cSDH in our cohort in the setting of new trauma after hospital discharge. There was one complication related to the MMAe procedure which was a femoral artery pseudoaneurysm that resolved without further treatment. Median baseline mRS was 3 prior to MMAe and median follow-up mRS after treatment was 2.

MMAe is a safe and efficacious treatment for nonagenarian patients with cSDH, and shows promise as a potential primary treatment modality.

Frailty occurs frequently among patients with advanced chronic kidney disease, especially among women. Assessing frailty in kidney transplant (KT) candidates is crucial for informing them about associated risks. However, there is poor agreement between frailty scales and research on their correlation with transplant outcomes. Being prefrail significantly impacts both graft and patient survival, often beginning with just 1 Fried criterion. Rather than viewing frailty as a categorical state, it should be regarded as a spectrum ranging from 1 to 5 criteria, with the risk of adverse outcomes escalating as frailty worsens. Frailty status fluctuates during the waiting period for KT; hence, a 1-time frailty evaluation is insufficient to determine risks and implement strategies for improving functional status. Further research should investigate the components of frailty that most frequently change during this waiting period and establish strategies to prevent or reverse frailty. Although careful evaluation of frail KT candidates is necessary to prevent early complications and mortality, exclusion based solely on a frailty score is unwarranted. Instead, efforts should focus on timely interventions to enhance their condition before transplantation. Although evidence is limited, exercise programs appear feasible and yield positive results. A pretransplant clinical framework encompassing multimodal prehabilitation-comprising physical therapy, nutritional measures, and psychological support-during the waiting list period may help alleviate the effects of frailty and poor fitness after KT, ultimately improving key outcomes. Despite logistical challenges, there is a pressing need for interventional trials in this area.

Frailty, an age-related syndrome, is associated with poor post-operative outcomes. The impact of community-level social determinants of health (SDoH) on pre-operative frailty has not been investigated yet. We developed a machine learning model to predict pre-operative frailty using an institutional dataset and applied it to a more geographically diverse population from the OneFlorida+ Clinical Research Consortium. Computable phenotyping for SDoH stratification using unsupervised learning was employed to identify distinct patient profiles based on zip code-level SDoH characteristics. We applied multivariate logistic regression to examine the association between SDoH profiles and pre-operative frailty risk. Adverse community-level SDoH profiles are independently associated with higher pre-operative frailty risk; patients from the disadvantaged SDoH profile had 1.21 times higher odds (95% CI 1.16-1.26) of being frail compared to the advantaged SDoH cluster after adjusting for potential confounders. Considering patients' social context could improve pre-operative care and surgical outcomes, informing clinical practice and policies.

Frailty, a geriatric syndrome characterized by decreased resilience and physiological reserve, impacts the prognosis and management of older adults significantly, particularly in the context of surgical and oncological care.

To provide an overview of frailty assessment in the management of older patients with a renal mass/renal cell carcinoma (RCC), focusing on its implications for diagnostic workup, treatment decisions, and clinical outcomes.

A narrative review of the literature was conducted, focusing on frailty definitions, assessment tools, and their application in geriatric oncology, applied to the field of RCC. Relevant studies addressing the prognostic value of frailty, its impact on treatment outcomes, and potential interventions were summarized.

Frailty is a poor prognostic factor and can influence decision-making in the management of both localized and metastatic RCC. Screening tools such as the Geriatric Screening Tool 8 (G8) and the Mini-COG test can aid clinicians to select older patients (ie, aged ≥65 yr) for a further comprehensive geriatric assessment (CGA) performed by dedicated geriatricians. The CGA provides insights to risk stratify patients and guide subsequent treatment pathways. As such, the involvement of geriatricians in multidisciplinary tumor boards emerges as an essential priority to address the complex needs of frail patients and optimize clinical outcomes. Herein, we propose a dedicated care pathway as a first key step to implement frailty assessment in clinical practice and research for RCC.

Frailty has emerged as a crucial factor influencing the management and outcomes of older patients with RCC. Involvement of geriatricians in diagnostic and therapeutic pathways represents a pragmatic approach to screen and assess frailty, fostering individualized treatment decisions according to holistic patient risk stratification.

Frailty, a decline in resilience and physiological reserve, influences treatment decisions and outcomes in elderly patients with renal cell carcinoma, guiding personalized care. In this review, we focused on pragmatic strategies to screen patients with a renal mass suspected for renal cell carcinoma, who are older than 65 yr, for frailty and on personalized management algorithms integrating geriatric input beyond patient- and tumor-related factors.

Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.

We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 < 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type.

Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36-3.64) and 4.64 days (95 % CI 3.96-5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79-3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48-0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47-0.59).

Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.

Although baby boomer generation accounts for a little more than 15% of the US population, the cohort represents a disproportionate percentage of patients undergoing surgery. As this group continues to age, a multitude of challenges have arisen in health care regarding the safest and most effective means of providing anesthesia services to these patients. Many older adults patients may be exquisitely sensitive to the effects of anesthesia and surgery and may experience cognitive and physical decline before, during, or after hospital admission. In this review article, the authors briefly examine the physiologic processes underlying aging and explore steps necessary to deliver safe, empathetic care.

This study aims to evaluate the potential association of perioperative hearing outcomes with frailty by Modified 5-Item Frailty Index (mFI-5).

Retrospective cross-sectional study.

Single-institutional study conducted at a tertiary care hospital between January 2018 and January 2022.

All adult patients older than 50 years who underwent cochlear implantation (CI).

Cochlear implantation.

Hearing outcomes were measured using pre-CI and longitudinal post-CI quiet AzBio scores. Frailty was determined by mFI-5 scores (0 = not frail, 1 = prefrail, and 2+ = frail). Univariable and multivariable linear regressions, ordinal logistic regressions, and time-to-event curves were used to determine perioperative speech perception and likelihood of high-performance hearing (defined as ≥70% on AzBio).

Of the 126 patients, the median age was 70 (63-77) years, 50% (63) were female, and 39% (49) identified as non-Hispanic Black, Hispanic, or other. By mFI-5 scoring, 38% (48) had no frailty, with 34% (43) and 28% (35) scoring 1 and 2+, respectively. When adjusting for age, sex, race, and BMI, scoring 1 point on mFI-5 was associated with significantly lower pre-implantation and post-implantation AzBio scores (pre: = -15 [-26, -3.4], p < 0.05; post: = -14 [-25, -3.0], p < 0.05). When controlling for all covariates, prefrailty and frailty were associated with significantly decreased likelihood of high-performance hearing (prefrailty OR: 0.22 [0.07, 0.63], p < 0.01; frailty OR: 0.31 [0.10, 0.92], p < 0.05). Time-to-event curves demonstrate significantly reduced likelihood of reaching high-performance hearing within 7 months after CI in patients with mFI-5 scores >0 (p < 0.05).

Our findings suggest that prefrailty is associated with worse pre-CI and post-CI hearing and lower likelihood of high-performance hearing within 7 months post-CI. Preoperative frailty screening in adult CI candidates may better inform providers of patients' long-term risk-to-benefit.

Frailty is a predictor of morbidity and mortality in older patients. This study aimed to investigate the influence of frailty status on likelihood, rate, duration, and severity of intraoperative hypotension (IOH), which can lead to severe organ dysfunction.

Surgical patients (≥70 yr old) with preoperative frailty assessment were analysed retrospectively. Frailty status was defined as robust, prefrail, or frail based on modified Fried criteria. IOH was defined as mean arterial pressure <65 mm Hg. For likelihood, rate, duration, and severity of IOH, logistic and Poisson regression were used.

We included 2495 patients. There was no significant difference in likelihood of IOH. An increase of 9% in rate of IOH during surgery for prefrail (incidence rate ratio [IRR] 1.09 [95% CI 1.03-1.16], P=0.002), and 16% increase for frail patients (IRR 1.16 [1.04-1.29], P=0.007) was observed. During anaesthesia induction, prefrail patients exhibited a 28% increase in IOH (IRR 1.28 [1.12-1.47], P<0.001). Although there were no differences in the severity of IOH if surgery or anaesthesia induction duration was taken into account, frailty status was associated with a 15% longer time-weighted duration of IOH during anaesthesia induction (IRR 1.15 [1.06-1.24], P=0.001). Mediator analysis revealed that frailty status accounted for >90% after considering number of measured blood pressures and surgical duration and >70% after accounting for total propofol dose.

Prefrail and frail patients aged ≥70 yr experienced up to 16% more IOH during surgery and 28% more during anaesthesia induction compared with robust patients. Preoperative optimisation (prehabilitation) and modification of intraoperative management (e.g. invasive blood pressure management) have the potential to reduce IOH in prefrail and frail patients.