Preoperative prediction of adverse outcome after elective gastrointestinal surgery in older patients: three leading frailty instruments and the American Society of Anesthesiologists physical status

Objective: This study aimed to compare the ability of three frailty assessments to predict adverse outcomes after elective gastrointestinal surgery and analyze how frailty assessments impact the American Society of Anesthesiologists (ASA) risk prediction model. Methods: Frailty was measured using the FRAIL scale, Fried Phenotype (FP), and Clinical Frailty Scale (CFS), alongside ASA assessments before surgery. Univariate and logistic regression analyses were used to determine the predictive value of each method. The predictive abilities of the tools were assessed by the area under the receiver operating characteristic curves (AUCs) and their 95% confidence intervals (CIs). Results: After adjusting for age and other risk factors, logistic regression analysis revealed significant positive associations between preoperative frailty and postoperative total adverse systemic complications (odds ratios [ORs] [95% CIs]: FRAIL, 1.297 [0.943-1.785]; FP, 1.317 [0.965-1.798]; CFS, 2.046 [1.413-3.015]; P < 0.001). The CFS was the best predictor of any adverse systemic complications (AUC, 0.696; 95% CI, 0.640-0.748). The predictive abilities of the FRAIL scale (AUC, 0.613; 95% CI, 0.555-0.669) and FP (AUC, 0.615; 95% CI, 0.557-0.671) were similar. The CFS and ASA assessment combined (AUC, 0.697; 95% CI, 0.641-0.749) had a statistically improved AUC compared to the ASA assessment alone (AUC, 0.636; 95% CI, 0.578-0.691), illustrating their value for predicting any adverse systemic complications. Conclusion: Frailty instruments enhance the accuracy of predicting postoperative outcome in older adults. Clinicians should add frailty assessments before preoperative ASA, particularly the CFS, given its ease of use and clinical feasibility.