Frailty and Surgery: Impact on Surgical and Anesthetic Outcomes

Frailty has emerged as a major determinant of perioperative risk because it reflects a multidimensional decline in physiological reserve that extends beyond chronological aging, comorbidity, or disability. It is characterized by reduced resilience across multiple organ systems and is commonly associated with sarcopenia, chronic low-grade inflammation, immune and neuroendocrine dysregulation, and metabolic and nutritional vulnerability. In surgical populations, frailty is highly prevalent, particularly among older adults and patients undergoing oncologic, cardiac, orthopedic, vascular, and abdominal procedures, making it a frequent and clinically relevant condition in perioperative care. Its importance lies in its strong association with adverse surgical and anesthetic outcomes. Frail patients experience higher perioperative and short-term mortality, more postoperative complications, longer hospital stays, increased readmissions, and a greater likelihood of non-home discharge. They are also more vulnerable to anesthetic complications because frailty alters pharmacokinetics and pharmacodynamics, increases sensitivity to anesthetics, sedatives, and opioids, and predisposes to hypotension and hemodynamic instability. In addition, frailty is closely linked to postoperative delirium, cognitive dysfunction, delayed mobilization, functional decline, and loss of independence, thereby affecting not only early recovery but also long-term quality of life. Given these consequences, frailty assessment should be incorporated into routine preoperative evaluation. Tools such as the Fried Frailty Phenotype, the Accumulated Frailty Index, the Clinical Frailty Scale, and the Edmonton Frail Scale can support perioperative risk stratification and individualized planning. Furthermore, strategies including prehabilitation, nutritional and functional optimization, correction of anemia and comorbidities, polypharmacy review, delirium prevention, multidisciplinary care, and shared decision-making may help reduce complications and improve patient-centered surgical outcomes.