•       The population aged 65 years and over worldwide is predicted to reach 1.6 billion by year 2050. 

•       ‘Frailty’, a recent concept in anesthesiology and peri-operative medicine, is defined as diminished physiological reserve predisposing to adverse outcomes when exposed to stressors.

•       Sarcopenia’, defined as an age-related loss of muscle mass and muscle function is an important precursor of physical frailty, mobility limitation, and premature death and can be used as a non-subjective phenotypic marker of frailty.

•       As there is an increasing number of older patients undergoing surgery, anesthesiologists will be faced with more frail patients in their daily work.

•       Preoperative fasting, effects of anesthetic agents, intraoperative blood loss, postoperative pain, nausea and vomiting and immobility during the perioperative period are insults for an already frail body.

•       Various questionnaire-based scales like Edmonton frailty scale, Fried phenotype5, PRISMA-7 ,Clinical frailty scale etc. are used for assessment of frailty but are subjective, tedious and time consuming.

•       Imaging modalities like dual-energy x-ray absorptiometry, magnetic resonance imaging, computed tomography are currently an area of research to bridge the gap between clinical assessment scales and objective markers of frailty but are expensive and can not be performed bedside.

•       Detection of sarcopenia using ultrasound which is a non invasive and comparatively cheaper method has recently gained popularity and protocols for the same have been updated in 2021.

•       Sarcopenia affects predominantly lower limb muscles than upper limb  muscles and hence muscle thickness and cross sectional area of rectus femoris muscle which is superficial, easier to trace by ultrasound and significantly affected in frail patients have been chosen as sarcopenia detection parameters in our study.

•       Therefore we have planned this study with an aim to know the proportion of sarcopenia detected by preoperative point of care ultrasound of rectus femoris muscle in elderly patients undergoing major surgery and its association with postoperative morbidity.