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Heterogeneity Within Frailty: Physiological Reserve Phenotypes and Postoperative Recovery After Abdominal Surgery
Rafał Cudnik1, Luigi Marano2,3, Elena Montanari4
1Emergency Department, "Saint Wojciech" Hospital, "Nicolaus Copernicus" Health Center, 80-530 Gdańsk, Poland.
Journal of Clinical Medicine
|February 13, 2026
Summary
Postoperative length of stay (LOS) is better predicted by frailty and muscle strength than chronological age. Combining these measures identifies patient groups with distinct recovery patterns, improving surgical risk assessment.
Area of Science:
- Gerontology
- Surgical Outcomes
- Physiology
Background:
- Chronological age is a poor indicator of biological vulnerability in surgical patients.
- Frailty and muscle strength are key indicators of physiological reserve.
- The combined impact of frailty and muscle strength on postoperative length of stay (LOS) is understudied.
Purpose of the Study:
- To investigate the independent and combined effects of frailty and handgrip strength (HGS) on postoperative LOS.
- To explore whether physiological reserve phenotypes improve risk stratification compared to age alone.
Main Methods:
- Prospective, multicenter observational cohort study of 223 adults undergoing elective abdominal surgery.
- Frailty assessed using Fried phenotype; HGS measured via dynamometer.
- LOS analyzed as prolonged (>10 days) and continuous; multivariable regression models used.
Main Results:
- Frailty (OR 3.12) and oncologic surgery (OR 7.63) independently predicted prolonged LOS; chronological age did not.
- Female sex was associated with lower odds of prolonged LOS (OR 0.39).
- Physiological reserve phenotypes showed graded LOS: Fit-Strong patients had shortest stays, Frail-Weak patients had longest.
Conclusions:
- Postoperative LOS is determined by multidimensional physiological reserve, not just chronological age.
- Integrating frailty and HGS identifies meaningful phenotypes for improved perioperative risk stratification.
- This approach can inform personalized perioperative planning and resource allocation.
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