Frailty in the perioperative setting: lessons from SNAP-3

The third Sprint National Anaesthesia Project (SNAP-3) is the largest prospective, multicentre UK study to examine the impact of frailty, multimorbidity, and delirium on postoperative outcomes in patients aged ≥60 yr. Conducted across 214 National Health Service (NHS) hospitals, SNAP-3 enrolled 7134 surgical patients over 5 days in March 2022. The investigators identified frailty in one-fifth of patients using multiple tools, including the Clinical Frailty Scale (CFS). Frailty was especially prevalent in emergency surgery and socioeconomically deprived populations. Multimorbidity was present in two-thirds of patients but only partially overlapped with frailty. Frailty was strongly associated with increased length of stay, delirium, complications, and mortality, with adverse outcomes escalating with higher CFS scores. In contrast, multimorbidity (without frailty) had limited association with most adverse outcomes. Directed acyclic graphs guided causal analysis, but by assuming frailty and multimorbidity were independent, the investigators might have underestimated the impact of multimorbidity. SNAP-3 highlights the need for routine perioperative frailty screening, comprehensive perioperative services, and workforce development. The data inform service planning and support prioritisation of frailty-focused care, especially in high-burden specialties and deprived areas.