The role of frailty and prehabilitation in surgery.

Abstract

The aging surgical population constitutes a unique challenge to clinicians across the spectrum of care. Frailty is a valuable tool for preoperative risk stratification and may guide targeted interventions, such as prehabilitation. The aim of this review is to revise the recent literature on the role of frailty and prehabilitation to optimize geriatric patients undergoing surgery. The concept of frailty became more refined over the past couple of decades, and its various dimensions have been operationalized into an array of different frailty scoring systems. The association between frailty and adverse perioperative events has been demonstrated in many surgical specialties. The use of multimodal prehabilitation of frail patients is expanding, and most prehabilitation programs (which focus on nutritional supplementation, feedback-based exercise regimens, and pulmonary optimization) have promising outcomes. Frailty is a valuable risk stratification tool that better captures the state of augmented vulnerability of older adults. Frail patients benefit from targeted interventions, such as multimodal prehabilitation. Thus, the implementation of nationwide geriatric surgery standards can address ongoing challenges in performing surgery on older, frail patients.