Preoperative Evaluation of the Frail Patient

Lolita S. Nidadavolu, MD, PhD; April L. Ehrlich, MD; Frederick E. Sieber, MD; Esther S. Oh, MD, PhD


Anesth Analg. 2020;130(6):1493-1503. 

In This Article


Electronic databases including PubMed, Embase, and the Cochrane Library were searched with date restrictions of January 1, 2001 to August 22, 2019. We started our search in 2001 due to the publication of the Physical Frailty Phenotype (PFP) and the Deficit Accumulation Index (DAI) frailty assessments in 2001.[3,9] A combination of controlled vocabulary and keyword terms was used for the concepts of frail elderly, preoperative care, assessment, complications or outcomes, and survey instruments. A total of 1869 records were identified. Duplicate records were removed, and 1510 titles and abstracts were identified. Inclusion criteria are as follows: surgical population, age ≥65, frailty assessed by a validated tool, and reporting on postoperative complications and other clinical outcomes. Exclusion criteria are as follows: oncological surgeries or procedures, age <65, studies assessing different surgical techniques or approaches, studies focusing on the economic and financial impact of frailty, and conference abstracts. In addition, studies that did not utilize all components of previously validated frailty tools (eg, only using gait speed or handgrip strength) were excluded. We also reviewed reference lists in relevant review articles to identify additional studies. Articles were reviewed by L.S.N. and A.L.E., and consensus was reached for final inclusion of eligible studies. Of the 1869 articles initially identified, 32 articles met all inclusion and exclusion criteria (Supplemental Digital Content, Figure,