Surgical Risk Assessment: From Chronological Age to Frailty Status

The increasing older population presents unique challenges to the healthcare system, particularly in the field of surgery. Geriatric surgical patients, characterized by advanced age and often multiple comorbidities, increasingly require a multidisciplinary approach to optimize surgical outcomes and improve postoperative recovery. Between 30 and 45% of surgical patients display characteristics of frailty or pre-frailty, and many tools and scales have been validated for its identification. The inclusion of frailty status in surgical risk assessment has led to an increasing demand for geriatricians in surgical wards. Physical, nutritional, and psychological interventions for frail patients minimize operative stress, enhance functional recovery, and improve patient outcomes. Many international working groups are investigating the impact of frailty in the surgical setting. The management of geriatric surgical patients requires a comprehensive, multidisciplinary, and tailored approach. Preoperative risk assessment, early detection of risk factors, and optimized perioperative care are key elements for the ideal management of this frail population. Future goals focus on progressively integrating frailty assessment into the decision-making process to ensure a more comprehensive, patient-centered evaluation of the risks and benefits of surgery.