Association of Frailty with Intraoperative Complications in Older Patients Undergoing Elective Non-Cardiac Surgery

Background: Frailty is increasingly being recognized as a risk factor for adverse outcomes in older surgical patients undergoing surgery. We investigated the association between frailty and intraoperative complications using multiple frailty assessment tools in older patients undergoing elective intermediate- to high-risk non-cardiac surgery. Methods: This retrospective cohort study included 637 older patients scheduled for elective non-cardiac surgery. Frailty was assessed using the Clinical Frailty Scale (CFS), FRAIL scale, and modified Frailty Index-11 (mFI-11). The predictive ability of frailty tools was analyzed and compared using the area under the receiver operating characteristic curve (AUC). Results: Frailty was significantly associated with higher intraoperative complication rates (FRAIL scale: p = 0.01; mFI-11: p = 0.046). Patients considered frail using the mFI-11 were more likely to have unplanned intensive care unit admissions (p < 0.001). Those classified as frail by the FRAIL scale and mFI-11 had significantly higher rates of vasopressor/inotrope use (p = 0.001 and p = 0.005, respectively) and mechanical ventilation (p = 0.033 and p = 0.007, respectively). In the univariate analysis, frailty measured using the FRAIL scale was significantly associated with intraoperative complications (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.33-4.38; p = 0.004); this association was not significant in the multivariate analysis (adjusted OR, 1.69; 95% CI: 0.83-3.43; p = 0.148; AUC = 0.550). Atrial fibrillation, hemoglobin levels, anesthesia type, and surgical subspecialty were stronger predictors of intraoperative complications. Conclusions: Frailty assessments demonstrate the limited predictive ability for intraoperative complications. Specific comorbidities, surgical techniques, and anesthesia types play more critical roles. Comprehensive preoperative evaluations integrating frailty with broader risk stratification methods are necessary to enhance patient outcomes and ensure safety.