Can older surgical patients self-assess frailty status preoperatively?

Frailty is an established predictor of adverse postoperative outcomes, yet preoperative frailty assessment remains inconsistently implemented despite guideline recommendations. Early identification of frailty enables targeted perioperative assessment and optimisation, and has been associated with improved postoperative outcomes, including a reduction in 1-yr mortality. Asking patients to report their own frailty status before a preoperative assessment could play an important role in improving the assessment of frailty. In this context, the study by Alkadri and colleagues addresses an important practical question: can older surgical patients reliably assess their own frailty status using the Clinical Frailty Scale (CFS)? They report a substudy of a prospective cohort examining agreement between self-rated and clinician-rated preoperative CFS scores in patients aged 65 yr and older undergoing elective noncardiac surgery. Their findings suggest moderate agreement between patient and trained assessor ratings, but patient-rated CFS had insufficient sensitivity to replace clinician-led frailty assessment in routine practice.