FRAILTY AS A PREDICTOR OF COMPLICATIONS IN ELDERLY PATIENTS UNDERGOING ELECTIVE ONCOLOGICAL SURGERY: A REVIEW OF SCREENING AND PREOPERATIVE MANAGEMENT

Frailty in patients undergoing video-assisted thoracoscopic surgery for lung cancer: a narrative review of assessment, outcomes and prehabilitation.

BACKGROUND Older adults with lung cancer are increasingly being considered for video-assisted thoracoscopic surgery (VATS), including segmentectomy or lobectomy with lymph node assessment. Although VATS reduces surgical trauma compared with thoracotomy, it does not eliminate heterogeneity in physiological reserve, treatment tolerance, or postoperative recovery. Frailty may therefore complement conventional preoperative assessment, which is typically based on chronological age, comorbidity burden, pulmonary function, and cardiac risk. METHODS AND MAIN FINDINGS This narrative review summarises the evidence on frailty assessment, perioperative outcomes, and prehabilitation strategies in patients undergoing lung cancer surgery, with a particular emphasis on VATS. Practical tools, such as the Clinical Frailty Scale and 4-metre gait speed, may support routine screening because they are brief, feasible, and clinically interpretable. More comprehensive approaches, including multidimensional frailty indices, nutritional assessment, sarcopenia evaluation, and comprehensive geriatric assessment, may be useful for selected patients. Available evidence suggests that frailty is associated with postoperative pulmonary complications, prolonged hospitalisation, non-home discharge, increased healthcare utilisation, and mortality after lung resection. However, direct evidence from frail patients with lung cancer undergoing VATS remains limited, and many recommendations are extrapolated from mixed thoracic surgery cohorts, studies of open lung resection, geriatric oncology, and non-thoracic surgical literature. CONCLUSIONS Frailty should be considered an actionable component of perioperative risk stratification, rather than a stand-alone criterion for determining surgical eligibility or the extent of VATS resection. Future studies in thoracic oncology should define optimal frailty assessment pathways and determine whether frailty-guided interventions can improve short-term recovery, long-term functional outcomes, tolerance of adjuvant therapy, and oncological outcomes after minimally invasive lung cancer surgery.

Association between preoperative oral frailty and postoperative infectious complications in patients undergoing colorectal cancer surgery: a retrospective analysis using the oral frailty index-8.

Modified 5-Item Frailty Index Is Associated with Postoperative Delirium but Not Survival in Patients Undergoing Surgery for Oral Squamous Cell Carcinoma

Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated the association between mFI-5-defined frailty and postoperative complications, especially postoperative delirium, as well as survival outcomes in patients undergoing surgery for OSCC. Methods: We retrospectively analyzed 127 patients who underwent surgical resection for OSCC with postoperative high care unit (HCU) management between 2013 and 2021. Frailty was defined as an mFI-5 score of ≥2. Clinical characteristics, postoperative outcomes, HCU stay, length of hospital stay, overall survival (OS), and disease-free survival (DFS) were compared between frail and non-frail groups. Univariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications. An exploratory multivariable logistic regression analysis for postoperative delirium was performed using age ≥65 years and sex as covariates. Delirium was retrospectively assessed from clinical documentation considered consistent with DSM-5 criteria. Results: Twenty-one patients (16.5%) were classified as frail. Postoperative delirium occurred more frequently in frail patients than in non-frail patients (42.9% vs. 19.8%; p = 0.023). In a multivariable logistic regression model adjusted for age ≥65 years and sex, mFI-5-defined frailty was significantly associated with postoperative delirium (adjusted OR, 3.07; 95% CI, 1.08–8.60; p = 0.035). No significant association was observed for pneumonia, surgical site infection, or free-flap reoperation. Frailty was not significantly associated with HCU stay, length of hospital stay, OS, or DFS. Conclusions: mFI-5-defined frailty was associated with postoperative delirium but not with survival outcomes in this OSCC cohort. Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor. Comprehensive perioperative assessment incorporating frailty, nutrition, sarcopenia, cognition, tumor burden, and treatment-related factors may better identify patients at risk.

Comment on “A High Frailty Burden Is a Strong Predictor of Adverse Postoperative Outcomes in Geriatric Lumbar Spine Surgery: A Retrospective Cohort Study”

While the study successfully establishes a statistical association, it is believed a deeper discussion is warranted regarding the distinction between population-level risk markers and individual-level predictive tools, the robustness of the causal inference, and the holistic interpretation of surgical benefit.

Development and validation of a multivariable risk score for postoperative complications in urological surgery in older patients: FRAC cohort study.

A multivariable risk score incorporating SPPB alongside key clinical variables predicts 30-day postoperative complications in older urological patients and provides valuable objective frailty assessment for preoperative risk stratification.

The frail patient - frailty as a critical factor in surgical risk and postoperative outcomes.

Frailty is a multidimensional syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, significantly elevating the risk of postoperative complications, morbidity, and mortality. As the population ages, prevalence of frailty among surgical patients is rising. This article summarizes current knowledge on frailty as a key predictor of surgical risk, introduces validated tools for its assessment, and discusses their application in clinical practice. Furthermore, it highlights prehabilitation as an effective intervention to improve the patients' baseline condition and reduce postoperative complications. Based on available evidence, frailty is a modifiable condition whose early identification and targeted interventions have the potential to significantly influence surgical outcomes and overall patient prognosis. The article calls for routine integration of frailty assessment into perioperative clinical care.