Frailty patterns in European surgical patients

BACKGROUND Frailty represents a multidimensional decline in physiological reserve that increases vulnerability to surgical stress. Its perioperative dynamics and association with outcomes across diverse surgical populations remain insufficiently characterised. OBJECTIVE This study aimed to describe the prevalence of frailty before and after surgery and to evaluate its association with postoperative complications, mortality, and hospital length of stay. METHODS We conducted a prospective, multicentre European cohort study including adults undergoing elective or emergency surgery under general or regional anaesthesia across 64 participating centres in 10 countries. Each centre contributed data from one to three predefined recruitment days between April 2021 and December 2022. Frailty was assessed preoperatively and at 30 days using the Rockwood Clinical Frailty Scale (CFS), the FRAIL questionnaire, and the Barthel Index. The primary outcome was the association between preoperative frailty and 30-day postoperative complications (Clavien–Dindo ≥ II); secondary outcomes included 30-day mortality, postoperative cognitive impairment, and new-onset frailty. RESULTS Among 1472 patients (mean age 60.9 years; 52.9% male), preoperative frailty prevalence was 14.6% (FRAIL), 10.4% (CFS), and 10.4% (Barthel). Within 30 days, 11.9% of nonfrail patients became frail, increasing overall frailty prevalence to 21.2%. Postoperative complications occurred in 19.2% and mortality in 1.7%. Preoperative frailty was independently associated with complications: adjusted odds ratio (OR) 2.35 [95% confidence interval (CI) 1.53 to 3.60], P < 0.001); 30-day mortality OR 10.9 (95% CI 1.28 to 93.0), P = 0.029). Frailty was also associated with postoperative cognitive impairment: OR 3.47 (95% CI 1.98 to 6.08), P < 0.001). CONCLUSIONS Frailty is common among surgical patients, increases after surgery, and independently predicts postoperative complications and mortality. These findings highlight frailty as a dynamic and potentially modifiable marker of surgical vulnerability that should be routinely assessed and integrated into perioperative care. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04140370