Risk assessment

Frailty

Also known as: perioperative frailty, frailty syndrome

Frailty is a state of reduced physiological reserve across multiple systems, leaving a patient vulnerable to stressors such as surgery. It independently predicts post-operative complications, longer stays, loss of independence and mortality — over and above age, ASA class or the specific procedure — which is why it is screened separately before elective surgery.

Definition
Reduced physiological reserve across multiple systems
Predicts
Complications, length of stay, loss of independence, mortality
Independent of
Chronological age, ASA class, procedure type
Related measure
Functional capacity (METs)

Why it is screened separately

The intuition that frailty is a proxy for age is wrong often enough to be dangerous in both directions. A robust 84-year-old and a frail 68-year-old have substantially different perioperative risk profiles, and neither is captured by age or by ASA class — a frail patient may well be classified ASA 2.

Because frailty predicts outcomes that matter to patients as much as to services — particularly loss of independence and discharge destination — it also changes the shape of the pre-operative conversation, not just the anaesthetic plan.

Where it fits in the assessment

Functional capacity and frailty is one of the 12 domains covered in the Socrates Pre-Op interview. Screening it on every patient rather than on those who look frail is the point: the patients whose reserve is quietly depleted are exactly the ones who present well in a short phone call.

Related terms

Prehabilitation

Prehabilitation is structured preparation before surgery — typically exercise, nutrition and psychological support, alongside smoking and alcohol reduction — aimed at improving a patient's physiological reserve before the stress of an operation. It treats the wait for surgery as an intervention window rather than dead time, which requires identifying who would benefit early enough to act.

Functional capacity (METs)

Functional capacity describes how much physical activity a patient can perform, measured in metabolic equivalents (METs). One MET is resting oxygen consumption. Four METs — climbing a flight of stairs or walking up a hill — is the usual threshold below which perioperative guidelines suggest further cardiac assessment before non-cardiac surgery.

ASA physical status

The ASA physical status classification is a six-point scale published by the American Society of Anesthesiologists to describe a patient's systemic health before anaesthesia. ASA 1 is a normal healthy patient and ASA 6 is a declared brain-dead organ donor. It describes health, not surgical risk, and an "E" suffix marks emergency procedures.

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