Physiological Reserve Research Articles

Cardiovascular Anesthesia and Critical Care in the French West Indies: Historical Evolution and Current Prospects

Anesthesiology, the medical specialty that deals with the management of vital functions in patients undergoing surgery, has played an important role in the successful development of cardiac interventions worldwide. Tracing the historical roots of cardiac anesthesia and critical care from its inception in the late 1950s, a paradigm shift in perioperative care has been driven by a better understanding of the mechanisms of organ dysfunction in stressful conditions and technological advances regarding surgical approach, patient monitoring, and organ protection. Although progress in cardiac anesthesia and critical care lagged a little behind in Caribbean territories, successful achievements have been accomplished over the last forty years. Compared with Western countries, the greater prevalence of obesity, diabetes mellitus, and hypertension as well as specific diseases such as cardiac amyloidosis, sickle cell anemia, rheumatic heart disease, and tropical infections may reduce a patient’s physiologic reserve and increase the operative risk among the multi-ethnic population living in the French West Indies and Guiana. So far, cardiac anesthesiologists at the University Hospital of Martinique have demonstrated their abilities in implementing evidence-based clinical care processes and adaptating to efficiently working in a complex environment interacting with multiple partners. Attracting specialized physicians in dedicated cardiac surgical centers and the creation of a regional health network supported by governmental authorities, insurance companies, and charitable organizations are necessary to solve the unmet needs for invasive cardiac treatments in the Caribbean region.

Subjective and objectives measures of frailty among adults with advanced chronic kidney disease: a cross-sectional analysis of clinician misclassification.

Frailty is a recognisable clinical measure of impaired physiological reserve and vulnerability to adverse outcomes that is validated among patients with kidney disease. Practice patterns reveal inconsistent use of objective frailty measures by nephrologists, with clinicians prioritising subjective clinical impressions, possibly risking misclassification and discrimination. The aim of this study was to examine correlations between subjective and objective measures of frailty in a cohort of patients attending routine nephrologist review. Eighty-nine participants attending scheduled review with their primary treating nephrologist (n = 6) were included in cross-sectional analysis. Measured frailty based on Fried phenotype and subjective clinician impression were assessed for congruence using Pearson's correlation analysis and ĸ statistic. Ordinal logistic regression examined patient demographics associated with perceived frailty. Misclassification was explored using descriptive statistics and contingency table analysis. Frailty and prefrailty were prevalent by both objective and subjective means of assessment with minimal correlation between clinician impression and measured Fried phenotype (r = 0.50, P = 0.00, ĸ = 0.25, P = 0.00). Subjective clinician impression misclassified half of participants, influenced by surrogate frailty measures including female sex, comorbidity and reliance on a walking aid. Clinicians were equally likely to over-classify prefrailty as to under-recognise established frailty, with no evidence of systemic misclassification bias. Subjective clinican impression of frailty had a positive predictive value of 19.1% and a negative predictive value of 56.2%. Nephrologists' reliance on subjective clinical impressions that overlook or misclassify prefrailty offers incomplete prognostic assessment and potentially misses opportunities for early intervention.

Optimisation of the patient having oncological surgical through prehabilitation: a narrative review.

Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery. We searched databases of peer-reviewed research to identify appropriate papers. Keywords comprised 'prehabilitation', 'cancer surgery' and associated synonyms (prehab; pre-operative rehabilitation; cancer). The results were combined with articles identified by reviewing the references of key papers and the use of the grey literature to develop our discussion. We detail the different elements of prehabilitation (exercise, nutrition, psychological support) relevant to patients with cancer undergoing surgery, focusing on the recent evidence base and ongoing challenges. Within this, we consider the role of behaviour change in enabling patients to undertake prehabilitation interventions and reflect on the different models of prehabilitation that have been utilised. Facilitators and barriers to implementation of prehabilitation are explored. Key findings include positioning prehabilitation as an integral part of the oncological surgical pathway which includes, but is discrete from, medical optimisation. Prehabilitation has the potential to improve surgical outcomes for patients undergoing cancer surgery. Further evidence is needed to understand how and what we provide to patients as optimal exercise, nutrition and psychological interventions as part of their surgical care, and how we improve long-term lifestyle using behaviour change methodology. Digital technology offers the opportunity for scaling and greater personalisation of prehabilitation but needs to be deliberately fashioned to ensure equitable access.

Pain and Frailty in Childhood Cancer Survivors: A Narrative Review

A significant proportion of childhood cancer survivors experience persistent health problems related to cancer or cancer treatment exposures, including accelerated or early onset of aging. Survivors are more likely than non-cancer peers to present a frail phenotype suggestive of reduced physiologic reserve and have symptoms that interfere with function in daily life, including pain. Studies in the general population, mostly among older adults, suggest that pain is a significant contributor to development and progression of frail health. This association has not been explored among childhood cancer survivors. In this narrative review, we highlight this gap by summarizing the epidemiologic evidence on pain and frailty, including their prevalence, common risk factors, and correlates in childhood cancer survivors. We further discuss associations between pain and frailty in non-cancer populations, likely biological mechanisms in survivors, and potential interventions targeting both domains.

Comparative Efficacy of Videolaryngoscopy and Direct Laryngoscopy in Patients Living With Obesity: A Meta-Analysis.

Intubation in patients living with obesity poses unique challenges due to altered airway anatomy and reduced physiological reserve, increasing the risk of complications. In synthesizing evidence from multiple trials, our meta-analysis suggests that videolaryngoscopy may provide a higher likelihood of achieving successful intubation on the first attempt compared to direct laryngoscopy while not substantially increasing the procedure time. Videolaryngoscopy was associated with a significant increase in first-pass intubation success compared to direct laryngoscopy, with a pooled risk ratio (RR) of 0.42 (95% CI 0.22 - 0.78, p = 0.0064). There was no significant difference in time to intubation between the two techniques (standardised mean differences (SMD) 0.13, 95% CI -0.26 to 0.52, p = 0.51), a result approached with low certainty due to the high heterogeneity among studies. Although the underlying studies varied in their methods and patient populations, these findings support the consideration of videolaryngoscopy as a potentially more reliable and safer technique for airway management in patients with obesity.

THE IMPACT OF FRAILTY ON DISEASE PROGRESSION OF SYSTEMIC SCLEROSIS: A HYPOTHESIS

Frailty, a multidimensional syndrome marked by diminished physiological reserve and increased vulnerability, hasemerged as a critical concern in systemic sclerosis (SSc). Both age-related inflamm-aging and disease-related chronicinflammation contribute to the higher prevalence of frailty in SSc patients compared to their age-matched counterparts. Frailty in SSc is strongly associated with adverse outcomes, including skin involvement, increased disability, physical inactivity, higher hospitalization rates, malnutrition, severe gastrointestinal symptoms, interstitial lung disease, and elevated mortality. This hypothesis posits frailty as an overlooked factor in the progression and severity of SSc. Early identification of frailty at its pre-frailty stage is essential. Implementing targeted preventative strategies could mitigate its impact, significantly enhancing long-term disease management and clinical outcomes for patients with SSc.

Tranexamic acid in hip and spine surgery for children with cerebral palsy — a PRISMA-compliant scoping review

Many children with cerebral palsy (CP) are frail and require major hip and/or spine surgeries associated with substantial blood loss. Tranexamic acid (TXA) is commonly used to reduce blood loss, but there is uncertainty around the optimal dose and timing of administration. There have been reviews in sub-populations and specific dosing regimens, but a broad overview of the available literature is lacking. The aim of this review was to map available evidence on TXA in hip and spine surgery for children with CP. Given the heterogeneous literature, a prospectively registered scoping review was conducted. Eligibility criteria were broad. Three screeners were involved, with the senior author consulted when disagreements were not resolved through discussion.Titles and abstracts of 14,609 records were screened, with 52 records included. Two additional records were obtained from grey literature and citation searching. Cohort studies (50.0%) were the most common. Most records (76.9%) were on spine surgery. TXA dose varied widely. Loading doses range from 5 to 100 mg/kg and intraoperative infusions from 1 to 10 mg/kg/h. Dose was not reported in 35.2% of records. Primary outcome measures included blood loss and transfusion requirements. TXA was generally reported to be safe. None of the included records reported postoperative TXA administration.While TXA is generally considered safe, there was mixed evidence on efficacy. Much of the evidence was drawn from studies in which TXA was used in patients at higher risk of bleeding or with reduced physiological reserve. There was no evidence for TXA being used postoperatively, when a large proportion of transfusions occur.

Metallothionein-1A (MT1A) Gene Variability May Play a Role in Female Frailty: A Preliminary Study

Background/Objectives: Frailty is a complex geriatric syndrome resulting in decreased physiological reserve. While genetics plays a role, the underlying mechanisms remain unsolved. Metallothioneins (MTs), metal-binding proteins with high affinity for zinc, an essential mineral for many physiological functions, are involved in processes including oxidative stress and inflammation. We investigated the impact of genetic variations in MTs on frailty. Methods: 448 subjects (235 females and 213 males, median age of 76 years) were categorized into three frailty groups (non-frail/pre-frail/frail), by hierarchical cluster analysis based on cognitive status (MMSE), functional capacity (ADL), and physical strength (HGS). Subjects were analyzed for selected SNPs in MT1A, MT1B, MT2A, and MT3 genes by PCR-RFLP. Results: An association was found between the rs8052394-A/G (Lys51Arg) polymorphism in the MT1A gene and frailty in females both in binary (OR = 0.345, p = 0.037) and multinomial logistic regression (OR = 0.343, p = 0.036) corrected for age and sex, with carriers of the minor G-allele less likely to transition from non-frail to pre-frail status. Additionally, a significant association with albumin levels (beta = 0.231; p = 0.027) and a trend of association with CRP levels (beta = −1.563; p = 0.097) were observed for this SNP in non-frail females, both indicative of a low inflammatory status. However, Bonferroni correction for multiple SNPs and physiological parameters tested renders these results statistically non-significant. Conclusions: Although its associations do not survive Bonferroni correction, this exploratory study suggests a sex-specific influence of MT1A variability in frailty, likely affecting zinc availability, aligning with ongoing research on sex differences in frailty risk and progression. Larger studies are needed to validate these findings and clarify the mechanisms behind MTs’ variability in frailty progression.

Implementing My PreHab Program: How digital technology helped to bridge the hospital-community gap and streamline hospital processes

Surgery is a key component of healthcare systems, however, a patient’s journey to surgery can be long and complicated. Public patients awaiting non-urgent surgery, frequently experience significant periods on ‘hidden’ outpatient and surgical waitlists. Post-operative complications are also common, affecting 20% of procedures, placing a substantial burden on both patients and the healthcare system. These complications are associated with worse psychosocial outcomes, delayed function recovery, financial costs and reduced patient flow. With increasingly constrained resources, an ageing population and growing burden of chronic disease, there are challenges in providing accessible, affordable, and safe elective surgery. Prehabilitation (prehab) is any intervention prior to surgery aimed at improving health and wellbeing and developing physiological reserve to cope with the stress of surgery. With a clear need for earlier health optimisation, the challenge was supporting patients to prepare well for surgery without dedicated funding to support on-site, in-person prehab.

Frailty and Mortality Risk Among Dogs with Extreme Longevity: Development and Predictive Validity of a Clinical Frailty Index in the Exceptional Aging in Rottweilers Study.

Frailty refers to a state of increased vulnerability to mortality and other adverse outcomes as a consequence of age-related decline in physiologic reserve and function. Comparative biomedical scientists are relied upon to innovate approaches to enhance understanding of the similarities and differences between humans and other animal species that can impact healthy aging. The research aim of this study was to develop a clinical frailty index (FI) in the Exceptional Aging in Rottweilers Study (EARS) and test its ability to predict all-cause mortality in elderly dogs. EARS is an ongoing lifetime cohort study of pet dogs with extreme longevity living in North America. Living 30% longer than the breed average, these dogs represent the canine counterpart to human centenarians. A 34-item FI (EARS-FI) was constructed to assess deficit accumulation using clinical data collected by telephone interviews with owners of 93 dogs with extreme longevity. Health deficits across multiple domains, including cognitive and sensory, cardiovascular and endocrine, and mobility, were included. The association between EARS-FI and subsequent mortality was tested in Kaplan-Meier survival analysis and in age-adjusted Cox proportional hazard models. Median (interquartile range) EARS-FI was 0.43 (0.38-0.50), and the estimated frailty limit was 0.68, consistent with data reported in humans with extreme longevity. Frailty index increased with increasing chronological age (p < 0.001). Deficit accumulation was significantly associated with increased mortality risk. Age-adjusted hazard ratio for mortality per 0.01 unit increase in FI was 1.05 (95%CI, 1.02-1.08; p = 0.001). This work provides the first demonstration of a strong association between frailty and mortality risk in pet dogs with extreme longevity. Notably, EARS-FI showed key features observed in the evaluation of frailty in aging human populations: heterogeneity, increase with chronological age, and estimated limit of <0.7. Validated here as a predictor of mortality in aged pet dogs, EARS-FI offers a useful tool for further comparative analyses of the linkages between deficit accumulation, mortality, and other adverse health outcomes.

Association of Physiological Reserve Obtained from Cardiopulmonary Exercise Testing and Frailty with All-Cause Mortality in Patients on Hemodialysis.

Potential impairment of exercise capacity is prevalent even in patients undergoing hemodialysis without frailty. Cardiopulmonary exercise testing (CPET) can detect physiological reserves such as cardiopulmonary, muscle, and autonomic function. We hypothesized that these indices could accurately determine the prognosis of patients on hemodialysis and analyzed them based on their relationship to frailty. In this two-center prospective cohort study hemodialysis patients from Japan, participants underwent CPET and physical assessment to evaluate peak oxygen uptake (peak VO2, indicator of exercise capacity), peak work rate (WR, indicator of muscle function), ventilatory equivalent for carbon dioxide (VE/VCO2) slope (indicator of cardiac reserve), heart rate reserve (indicator of chronotropic incompetence), and frailty phenotype. Survival was followed-up for up to 5 years. Data from 189 patients (median [IQR] age: 71 [62, 77] years) were analyzed. All CPET indicators showed a consistent nonlinear relationship with all-cause mortality after adjustment: for peak VO2, hazard ratio [HR] 0.79 [95% CI: 0.71, 0.88], P <0.001; for peak WR, HR 0.95 [95% CI: 0.93, 0.97], P <0.001; for VE/VCO2 slope, HR 1.09 [95% CI: 1.05, 1.13], P <0.001; for heart rate reserve, HR 0.96 [95% CI: 0.93, 0.99], P=0.02). Frailty phenotype was associated with mortality after adjustment (HR 1.73 [95% CI: 1.06, 2.81], P=0.03); however, this association was not statistically significant in the model after adding peak VO2 (P=0.41). Furthermore, in both subgroups with and without frailty, CPET measures were significantly associated with mortality risk (peak VO2, peak WR, and VE/VCO2 slope: P <0.05). The peak VO2 (Δ area under the curve [AUC] 0.09, 95% CI: 0.02, 0.16) or the peak WR (ΔAUC 0.09, 95% CI: 0.02, 0.15) most significantly improved the prognostic accuracy. Results showed the fragile aspect of the frailty phenotype in the hemodialysis population and the superior ability of CPET to indicate death risk complementing that aspect.

The Importance of Multidimensional Frailty in Clinical Practice

Frailty in older adults is a complex, multidimensional syndrome characterized by decreased physiological reserves and increased vulnerability to stressors [...]

Gut microbiota changes associated with frailty in older adults: A systematic review of observational studies.

Frailty is a complex aging-related syndrome characterized by a cumulative loss of physiological reserve and increased vulnerability to adverse clinical outcomes, including falls, disability, incapacity and death. While an increasing number of studies suggest that the gut microbiota may play a key role in the pathophysiology of frailty, direct evaluation of the association between gut microbiome alterations and frailty in older adults remains limited. To gain insight into gut dysbiosis in frail older adults. Seven electronic databases (China National Knowledge Infrastructure, VIP, SinoMed, Wanfang, PubMed, Web of Science and EMBASE) were searched for articles published before October 31, 2023 to identify observational studies that compared the microbiomes of older adults with and without frailty. The diversity and composition of the gut microbiota were the main outcomes used to analyze the associations of changes in the gut microbiota with frailty in older adults. The quality of the included studies was assessed via the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality. Eleven observational studies with 912 older adults were included in this review. Consistent results revealed a significant difference in the gut microbiota composition between frail and non-frail older adults, with a significant decrease in α diversity and a significant increase in β diversity in frail older adults. The pooled results revealed that at the phylum level, four microbiota (Actinobacteria, Proteobacteria, Verrucomicrobia and Synergistetes) were significantly enriched, and two microbiota (Firmicutes and Fusobacteria) were significantly depleted in frail older adults. At the family level, the results consistently revealed that the abundances of 6 families, most of which belong to the Actinobacteria or Proteobacteria phylum, were greater in frail than in non-frail older adults. At the genus or species level, consistent results from more than two studies revealed that the abundances of the genera Prevotella, Faecalibacterium, and Roseburia were significantly lower in frail older adults; individual studies revealed that the abundances of some genera or species (e.g., Megamonas, Blautia, and Megasphaera) were significantly lower, whereas those of other genera or species (e.g., Bifidobacterium, Oscillospira, Ruminococcus and Pyramidobacter) were significantly greater in frail older adults. This systematic review suggests that changes in the gut microbiota are associated with frailty in older adults, which is commonly reflected by a reduction in beneficial species and an increase in pathogenic species. However, further studies are needed to confirm these findings.

Multimodal prehabilitation combined with perioperative enhanced recovery after surgery care for older patients undergoing spinal fusion surgery in China: protocol for a multicentre randomised controlled trial (PRACTICE trial)

IntroductionBesides the comorbid risk factors shared by older and younger patients, older individuals may also experience malnutrition, as well as cognitive or functional impairments. The accumulation of frailty and various...

The Fragile Brain: Understanding Frailty in Neuroanesthesia

AbstractFrailty is a multidimensional geriatric syndrome characterized by decreased physiological reserve, making patients more vulnerable to stressors, such as surgery and anesthesia. In neuroanesthesia, frailty is particularly relevant due to the high-risk nature of neurosurgical procedures and the potential for significant perioperative stress. Although there are several studies on the implications of frailty in spine surgery, there are lacunae in the knowledge understanding and frailty risk assessment in the cranial cohort of neurosurgical patients. A systemic review process with a qualitative data analysis of the available literature was used to extract data for this review. By identifying, acknowledging, and addressing the knowledge gaps in our understanding of frailty, specifically the cranial cohort, and developing a neuroanesthesia-specific frailty risk index, along with establishing best practice strategy guidelines and institutional protocols, neuroanesthesiologists will enhance and optimize outcomes.

Perspectives on Frailty Among Emergency Physicians: A Qualitative Descriptive Study.

Background The proportion of older people in the general population is rising. Accompanying this rise is an increased prevalence of frailty. Frailty is a syndrome of increased vulnerability to stressors due to decreased physiological reserve and is linked to increased health services use. Frailty assessment provides a comprehensive insight into an older person's health status but is not regularly performed in emergency departments (EDs) worldwide. Understanding emergency physicians' (EPs) perspectives on frailty could assist in facilitating the implementation of frailty assessments in the ED. However, little is known about EP perceptions of frailty. Objectives The aim of this study was to explore perspectives on frailty among EPs. Design An exploratory qualitative descriptive study was conducted. EPs' perspectives on frailty were explored in semi-structured interviews, including questions on the meaning of frailty, its detection, management, and potential to improve the care of frail ED patients. Interviews were recorded and transcribed. Setting Central Adelaide Local Health Network, which has two EDs in Adelaide, South Australia. Participants Sixteen EPs were interviewed. Eleven (69%) were male EPs and 10 (63%) were practicing as EPs for 4 years or less. Measurements We analyzed interview transcripts by inductive thematic analysis. We generated, iteratively revised, and applied a coding framework, enabling progression to the formulation of themes. Results We developed three themes. Theme 1: EPs did not perceive frailty as a priority of care due to their focus on acuity, and lack of knowledge, time, and resources. Theme 2: EPs referred to detecting and managing frailty indirectly rather than formally. Theme 3: EPs saw a beneficial role in frailty recognition and management in the future. Conclusions EPs did not perceive frailty as a priority of care. However, they had a positive view on progressing with increased frailty awareness and holistic management in EM, for patient and health system benefits.

Antimicrobial Stewardship in the Frail Elderly.

Antimicrobial therapy is essential to modern healthcare practice. However, years of injudicious use has contributed to the development of population and individual level harm from antimicrobial resistance. The frail elderly are particularly at risk from infection as well as antimicrobial adverse effects due to multimorbidity, polypharmacy and declining physiological reserve. Diagnosis and management decision making may be challenging in this vulnerable group due to subtle or absent symptoms and signs. Antimicrobial stewardship is the systematic approach to safe and effective use of antimicrobials to optimise outcomes, minimise harm and preserve future therapies. Herein, we consider the significance and importance of antimicrobial stewardship in the frail elderly and suggest ten steps to assist clinicians in the recognition, investigation and management of infection in this group.

Frailty reduces penumbral volumes and attenuates treatment response in hyperacute ischemic stroke.

Frailty-the loss of physiological reserve to withstand a stressor event-is associated with poorer outcomes following acute stroke reperfusion therapies. However, the mechanisms underlying this relationship are poorly understood. This study investigated the association between frailty and penumbral volumes in hyperacute ischemic stroke. Total ischemic lesion volumes (comprising infarct core and penumbral volumes) were measured using computed tomography (CT) perfusion imaging to give the penumbral fraction within the ischemic lesion. Pre-stroke frailty was measured using a validated frailty index. The relationship between frailty and penumbral fraction was adjusted for age, onset-to-CT interval, collateral scores, small vessel disease burden and vascular comorbidities. Stroke severity was measured using the National Institutes of Health Stroke Scale at baseline and after 24h. In 55 individuals receiving thrombolysis for ischemic stroke, increasing frailty was associated with a reduction in penumbral fraction (rs = -0.36, P < 0.01). This remained significant after adjustment for age, onset-to-imaging time and collateral score (beta = -1.16, P < 0.001). Correspondingly, frailty was independently negatively associated with proportional improvement in stroke severity following treatment (beta = -2.00, P < 0.01). C-reactive protein (CRP) on presentation was associated with frailty index (rs = 0.38, P < 0.01) and penumbral fraction (rs = -0.30, P = 0.02). A reduction in salvageable penumbra in frailty may explain the treatment-attenuating effects of frailty on reperfusion therapies. The association with CRP motivates further research into a possible inflammatory component of this relationship. Frailty is independently associated with reduced penumbra and poorer neurological recovery in acute stroke. These findings may explain the attenuated response to stroke reperfusion therapies seen in frailer individuals.

Frailty in kidney transplant recipients.

Kidney transplantation is the treatment of choice even for the elderly, as it improves quality of life and life expectancy, lowering the financial burden to the health care system compared to dialysis therapy. In Japan, kidney transplant recipients have become older due to the shift in demographics. Compared to community-dwelling elderly adults, elderly kidney transplant recipients undergoing immunosuppressive therapy have a higher risk of age-related outcomes including hospital readmissions, infections, dementia, malignancies, and fractures. In frailty, patients become vulnerable to adverse events after stressors due to a lack of physiologic reserve. Although it is often associated with aging, frailty can also occur in younger individuals with certain chronic illnesses or conditions including chronic kidney disease. Limited compensatory mechanisms result in functional impairment and adverse health outcomes, such as disability, falls, decreased mobility, hospitalization, and death. Although kidney transplant recipients can restore their kidney function after transplantation, most of them still have chronic kidney disease, as well as a gradual decline in graft function as a result of chronic allograft nephropathy. Wait-listed candidates for kidney transplantation with frailty are more likely to experience wait-list removal or death. Frailty at the time of transplantation is associated with complications after kidney transplantation such as delayed graft function, longer hospital stays, rehospitalizations, immunosuppression intolerance, surgical complications, and death. Nevertheless, kidney transplantation can be a viable intervention for frailty in dialysis patients.

Implementation of a Preoperative Frailty Screening and Optimization Pathway for Vascular Surgery Patients is Associated with Decreased 30-Day Readmission

Frailty is characterized by decreased physiological reserve and vulnerability to adverse events in the presence of a stressor such as surgery. We prospectively implemented a preoperative frailty screening and optimization pathway for patients undergoing vascular surgery and assessed its impact on postoperative outcomes. As part of an ongoing quality improvement initiative, surgical frailty was assessed prospectively in all patients undergoing inpatient surgery using the Risk Analysis Index (RAI). Baseline data were collected from May to July 2022. Frail patients (RAI score of ≥37) were referred to an anesthesia optimization clinic, nutrition consultation, and case management evaluation in the intervention phase (August 2022 to July 2023). Primary outcomes were postoperative hospital length of stay, 30-day readmission, and 30-day mortality. Secondary outcomes included intensive care unit (ICU) admission, ICU length of stay, discharge disposition, and nonhome discharge. Two-way analyses compared frail vs nonfrail patients and preintervention vs postintervention groups using the Student t test or Wilcoxon rank-sum test for continuous variables and the χ2 or Fisher's exact test for categorical outcomes. Of all patients scheduled for elective inpatient vascular surgery procedures at a single institution (n= 225), 216 completed frailty screening (mean age, 72years; 68.5% male; 54.6% White; mean RAI 28.9; 18.5% frail). Of these, 15 had surgeries cancelled, and 201 ultimately underwent surgery with 36 (17.9%) identified as frail. Overall, frail patients had significantly longer ICU (median, 4.0 days [intertquretil range (IQR), 2.5-13.5 days] vs median, 2.0 days [IQR, 1-4 days]; P=.001) and hospital length of stay (median, 2.45 days [IQR, 1.51-5.67 days] vs median, 1.23 days [IQR, 1.0-2.1 days]; P= .001), higher nonhome discharge (30.6% vs 4.2%; P< .0001), and higher 30-day readmission (22.2% vs 6.7%; P= .009) compared with nonfrail patients. Comparing preintervention and postintervention groups, the 30-day readmission rates for the overall cohort decreased significantly (from 22.2% to 7.5%; P= .03). Among frail patients, there was a trend toward a reduced hospital length of stay (from 4.73 to 2.14days), nonhome discharge (from 57.1% to 24.1%), and 30-day readmission (from 42.9% to 17.2%); however, these differences did not reach statistical significance. Overall, the 30-day mortality rates was 1.5% with all three deaths (two frail, one nonfrail) occurring after the intervention (0% before vs 1.7% after; P= 1.0). Successful implementation of a preoperative frailty screening and optimization pathway for patients undergoing elective vascular surgery led to a significant decrease in overall 30-day readmission and a trend toward reduced hospital length of stay, nonhome discharge, and 30-day readmission for frail patients. Further expansion to all surgical clinics has the potential to improve quality metrics for the health care system.