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Frailty patterns in European surgical patients: The FRAGILE multicentre prospective cohort
Cesar Aldecoa1, Andres Zorrilla-Vaca, Javier Ripolles-Melchor
1From the The Anaesthesia and Surgical Critical Care Department, Hospital Universitario Rio Hortega, Valladolid (CA), CIBER of Respiratory Disease, Carlos III Health Institute, Madrid, Spain (CA, CF), the Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (AZV, NG), the Department of Anesthesiology, Infanta Leonor Universitario Hospital, Madrid (JRM), IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy (MC), the Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini, Pieve Emanuele, MI, Italy (MC), Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", 57010 Thessaloniki, Greece (OI,), Department of Anesthesiology and Reanimation, Medicine Faculty of Ankara University, Ankara, Türkiye (BCM), Department of Anesthesiology and Intensive Care Medicine, Faculty hospital in Plzen, Plzen, Czech Republic (JB, OS), Simulation centre (SIM/PL), Faculty of Medicine in Plzen - Charles University, Plzen, Czech Republic (JB, OS), the Department of Clinical Research, University of Basel, Basel, Switzerland (NG), the Anaesthesia and Critical Care Department, Hospital Clinic, Barcelona, Spain (NM, FWB, CF), the Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal (NT), the University Department of Geriatric Medicine FELIX PLATTER, Memory Clinic, Basel, Switzerland (AW), the Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland (AW), Department of Medicine, Surgery, and Neurosciences, University of Siena, Italy (LM), the Third Department of Surgery, Evangelismos General Hospital, Athens, Greece (MS), the Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria (GP), the Department of Anesthesiology, Maasstad Hospital, Rotterdam, the Netherlands (SK), the Anaesthesia and Critical Care Department, Donostia University Hospital, Donostia-San Sebastián, Spain (AAM).
Background:
Frailty represents a multidimensional decline in physiological reserve that increases vulnerability to surgical stress. Its perioperative dynamics and association with outcomes across diverse surgical populations remain insufficiently characterised.
Objective:
This study aimed to describe the prevalence of frailty before and after surgery and to evaluate its association with postoperative complications, mortality, and hospital length of stay.
Methods:
We conducted a prospective, multicentre European cohort study including adults undergoing elective or emergency surgery under general or regional anaesthesia across 64 participating centres in 10 countries. Each centre contributed data from one to three predefined recruitment days between April 2021 and December 2022. Frailty was assessed preoperatively and at 30 days using the Rockwood Clinical Frailty Scale (CFS), the FRAIL questionnaire, and the Barthel Index. The primary outcome was the association between preoperative frailty and 30-day postoperative complications (Clavien-Dindo ≥ II); secondary outcomes included 30-day mortality, postoperative cognitive impairment, and new-onset frailty.
Results:
Among 1472 patients (mean age 60.9 years; 52.9% male), preoperative frailty prevalence was 14.6% (FRAIL), 10.4% (CFS), and 10.4% (Barthel). Within 30 days, 11.9% of nonfrail patients became frail, increasing overall frailty prevalence to 21.2%. Postoperative complications occurred in 19.2% and mortality in 1.7%. Preoperative frailty was independently associated with complications: adjusted odds ratio (OR) 2.35 [95% confidence interval (CI) 1.53 to 3.60], P < 0.001); 30-day mortality OR 10.9 (95% CI 1.28 to 93.0), P = 0.029). Frailty was also associated with postoperative cognitive impairment: OR 3.47 (95% CI 1.98 to 6.08), P < 0.001).
Conclusions:
Frailty is common among surgical patients, increases after surgery, and independently predicts postoperative complications and mortality. These findings highlight frailty as a dynamic and potentially modifiable marker of surgical vulnerability that should be routinely assessed and integrated into perioperative care.
Trial Registration:
ClinicalTrials.gov identifier: NCT04140370.
