Frailty in anesthesia

Due to demographic change, the number of geriatric patients is increasing in the surgical field. This poses a major challenge in perioperative medicine. In order to improve patient safety, frailty has become a key element for risk assessment in the perioperative setting. This review aims to summarize the current state of anesthesia in frail patients.

Frailty is an independent risk factor for intraoperative and postoperative complications, mortality, and length of hospital stay. The Clinical Frailty Scale has been shown to be a feasible, easy-to-use tool for frailty assessment. Frailty is likely to be modified through targeted preoperative optimization (prehabilitation). This should be carried out on a multidisciplinary basis. During preoperative risk assessment, special attention should be paid to polypharmacy and multimorbidity. Particularly in geriatric patients, maintaining intra- and postoperative homeostasis is essential. Adequate pain management and prevention of perioperative delirium are of utmost importance.

Frailty is a common and highly relevant clinical risk factor in the perioperative setting. In future, efforts should focus on identifying methods to improve the status of preoperative frail patients.