Frailty as potential indicator of perioperative risk for older patients

Background Physical, cognitive and social frailty is increasingly being recognized as a prognostic factor in the perioperative treatment of older patients; however, the concept of frailty has not been introduced into clinical routine in anesthesia. Objectives Definition of terms, presentation of tools for determining the degree of frailty and measures to improve the clinical outcome of patients at risk. Proposal of a pragmatic approach for the detection and treatment of high-risk patients in everyday clinical practice. Material and methods Evaluation of current reviews and original publications. Discussion and modification of established frailty assessment tools in context of the needs in perioperative medicine. Results The degree of frailty is associated with the postoperative outcome. Depending on the definition used, the term frailty refers to a degraded resilience in the physical, mental or social domain. Although there is still no universal definition of frailty, it is clear that frailty is directly correlated with survival and postoperative morbidity. Classical perioperative risk markers such as age or ASA classification do not reach such high predictive value. For the perioperative screening and evaluation of frail patients, an adapted version of the MAGIC assessment in combination with two signal questions is recommended. The extent of frailty in a patient can be improved by a sufficient diet, by physiotherapeutic exercises and by providing cognitive aids; however, scientific proof that preoperative improvement of the frailty status subsequently improves postoperative results is available for only a few specific clinical conditions. Conclusion In contrast to commonly used perioperative risk classifications, frailty is a sensitive marker for the patient's biological age. Therefore, it appears more suitable for estimating the perioperative risk than chronological age or other conventional tools, such as the ASA classification and is therefore a prerequisite for patient centered treatment pathways.