Abstract
Objective: This study was aimed to determine preoperative frailty assessment screening on postoperative morbidity and postoperative loss of independence (LOI).
 Materials & Methods: A total of 100 patient’s age 65 years and older were included in this study. Edmodium Frail Scale (EFS) was used for the assessment of frailty. The surgical procedure was categorized on operative severity score, and Hierarchical Condition Category (HCC). The Chi-square test was applied to see the significant/insignificant differences between different stratified groups of patients.
 Results: The mean age of the patients was 68 years. There were 63% male and 37% female patients. Maximum patients (78%) who had no LOI were in age less than 80 years. 11% of patients who had LOI were only 11%. There existed a significant difference (p-value: 0.004) between age groups (greater than/less than 80 years) of patients and presence/absence of loss of independence (LOI). After EFS assessment, 32% of patients had limited mobility, 22% had weight loss, 19% reported depression, 9% of patients were socially dependent and 18% reported cognitive impairment. 
 Conclusion: The results suggest that frail patients older than 78 years and OSS > 3 had a more increased risk of postsurgical LOI. The patients with EFS >5 and OSS >3 had more LOI. EFS analysis explained that those patients with restricted mobility, depression, and dependent socially had increased LOI.
Highlights
Maximum patients (78%) who had no loss of independence (LOI) were in age less than 80 years. 11% of patients who had LOI were only 11%
The Operative Severity Score (OSS) was higher in patients with LOI as compared to patients without LOI
Edmodium Frail Scale (EFS) analysis explained that those patients with restricted mobility, depression, and dependent socially had increased LOI
Summary
The detailed discussion on the preoperative clinical status of older patients (65 years and above) guided the post-operative outcomes regarding morbidity and mortality.[1,2,3] Approximately more than 50 percent of operations globally are performed on patients of age more than 65 years.[1,3,4,7] Frailty in the population older than 65 years is between 10 – 37%.3,9,12 Older patients are more prone to develop anesthesia and operative complications in the postoperative period.[5,7,9] Increased surgical complications and lengthy hospital stays are reported in older frail patients.[1,3,5,7] Those frail patients who develop loss of independence (LOI) need trained rehabilitation centers in the postsurgical period when they discharge from primary hospital.[3,5,6] Since the emergence of the global pandemic of COVID 19, these rehabilitation centers are very prone to this viral infection with catastrophic outcomes.[1,2,11] Currently, there was a need for frailty assessment guidelines in the aging population of the World, It was incorporated by the American College of Surgeons together with the American Geriatrics Society in the year 2013. Older patients are more prone to develop anesthesia and operative complications in the postoperative period.[5,7,9] Increased surgical complications and lengthy hospital stays are reported in older frail patients.[1,3,5,7] Those frail patients who develop loss of independence (LOI) need trained rehabilitation centers in the postsurgical period when they discharge from primary hospital.[3,5,6] Since the emergence of the global pandemic of COVID 19, these rehabilitation centers are very prone to this viral infection with catastrophic outcomes.[1,2,11] Currently, there was a need for frailty assessment guidelines in the aging population of the World, It was incorporated by the American College of Surgeons together with the American Geriatrics Society in the year 2013. The EFS includes an 11 – point scale, 9 of which are self-reporting points This can assess psychosocial and cognition in the evaluation of frailty
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