Are the days gone when age mattered? A national-level comparison of frailty versus age in predicting postoperative outcomes

This study aimed to evaluate the relationship between age, frailty, and surgical outcomes in older adult populations undergoing low-, intermediate-, and high-risk general surgical operations.

This is a retrospective study of the 2022 National Surgical Quality Improvement Program. Adult patients (≥50 years) undergoing general surgery procedures were stratified by surgical risk (low, intermediate, and high). Patients were stratified based on decades of age and Modified Frailty Index score. The primary outcome was 30-day mortality, and secondary outcomes were 30-day readmission and major complications.

A total of 94,882 patients were identified, of which 63.4% underwent low-risk, 27% underwent intermediate-risk, and 9.6% underwent high-risk general surgeries. Cohen's kappa coefficient was 0.089, indicating poor agreement between frailty score and age category. On univariate and multivariable regression analysis, increasing frailty score was significantly associated with increased rates and adjusted odds of 30-day mortality, whereas age was not identified as a risk factor for this outcome. Subanalysis of outcomes identified frailty, but not age, as a predictor of 30-day mortality among patients who underwent low (adjusted odds ratio, 2.279; P < .001), intermediate (adjusted odds ratio, 1.465; P < .001), and high (adjusted odds ratio, 1.245; P < .03) risk surgeries.

Increasing frailty score, not age, was found to be significantly associated with mortality of older adults. Counterintuitively, as procedural risk decreased, the predictive strength of frailty on outcomes became more pronounced. The weak correlation between age and frailty further suggests that chronological age may no longer hold meaningful value in guiding surgical decisions for both minor and major general surgical operations.