The concept of surgical frailty
Although age by itself is certainly a predictive factor for adverse surgical outcomes, it is not absolute. There are many elderly patients who undergo surgical interventions and recover without incident. Yet, there is no denying that within this group, there are more patients who are potentially more at risk and thus being able to better objectify and identify this subset of patients is imperative.
Simply deferring or denying care based on age alone—a practice known as ageism—would unnecessarily prevent a majority of patients from receiving appropriate and life-saving surgery. Frailty is a relatively new concept that encompasses not only a patient’s chronologic age, but also a patient’s ability to withstand physiologic stressors. Fried et al initially introduced this concept and described frailty “as a biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, and causing vulnerability to adverse outcomes.”27
In their initial study, Fried and colleagues operationalized the measurement of frailty focusing on the following domains: shrinking (weight loss or sarcopenia), weakness, slowness, poor endurance/exhaustion, and low activity (Table 1).