According to Population Census 2011, there are nearly 104 million elderly persons (aged 60 years or above) in India; 53 million females and 51 million males. A report released by the United Nations Population Fund and Help Age India suggests that the number of elderly persons is expected to grow to 173 million by 2026 and to 300 million by 2050.

Older patients have worse outcomes than younger patients, with higher mortality, higher complications rates, adverse discharge outcomes and longer hospital stay. Development of adverse outcomes in the geriatric population cannot be explained solely by advanced age. Concomitantly, surgical practice patterns have evolved to prioritize the maximization of disease management over the potential risks of surgery in the elderly. The large and increasing proportion of surgical procedures performed on this aging population of patients has made it incumbent on the anaesthetic and surgical community to improve risk stratification. Therefore, we continue to seek additional factors that may predict a patient’s perioperative risk for major adverse events.

Frailty, in particular, has become an area of increased interest. Frailty is a multidimensional state of loss of physiologic reserves including energy, physical ability, cognition, and health that gives rise to vulnerability to poor health outcomes due to a decreased ability to withstand physiologic stress. But, there is no universal definition of frailty because assessments of frailty range from the very simple (number of outpatient medications) to the relatively complex (scored clock-drawing test).⁶There is consensus that frailty, as measured by any number of these metrics, is associated with adverse perioperative outcomes including major morbidity, mortality, and increased length of stay.Therefore we planned a study to assess the adverse outcomes in geriatric population  by assessing the frailty.

Patients will be assessed and screened for frailty at the time of pre-anaesthetic check-up, prior to the surgery. Frailty will be assessed by the CFS and F1 LAB scores. Assessors may not be present daily and data will be collected on days the patient will be operated. Some of patients who will get re-do for the same surgery, will also be considered.  A small number of patients may be operated for > 1 procedure after assessment, the surgery with higher complexities will be used.  The Clinical frailty scale and the F1 LAB are defined below.

Clinical Frailty Scale:

The geriatrician determines the CFS score during the initial consultation, through history obtained from the patient, family, and/or other health care providers about comorbidities, energy level, and functional status. CFS scores of patients at the included in the study were abstracted from the comprehensive geriatric assessment. If the value was not available in the consultation note, a manual chart review was conducted to assign the score. Two raters independently determined the CFS score of each patient, and a third study author adjudicated any remaining conflicts after reconciliation of the scores. The CFS scores were stratified into 3 groups based on the CFS validation study¹³: 1 to 3 were “not frail,” 4 and 5 were “at risk to mildly frail,” and 6 and 7 were “frail.” The “at risk to mildly frail” group was separated into “apparently vulnerable” (CFS 4) and “mildly frail” (CFS 5) in the descriptive statistics and unadjusted analyses. (Appendix1)

Laboratory Frailty Index

The 23-item laboratory Frailty Index (FI-lab) was calculated based on first available values within 48 hours of presentation to hospital. The FI-lab was modified from the original version described by Howlett and colleagues¹⁴ to accommodate laboratory values readily available for a trauma patient. The venereal disease research laboratory test, T4, folate, and RBC folate were removed because very few patients had these parameters measured. These 4 variables were replaced by troponin, international normalized ratio, venous lactate, and oxygen saturation because they are commonly measured in the setting of trauma and meet the criteria for inclusion in a deficit accumulation frailty index (Table 1).¹¹ Admission FI-lab was calculated as described previously¹⁴ and was stratified into 3 groups according to the system proposed by Searle and associates¹⁵: FI < 0.25 is mild frailty, 0.25 ≤ FI ≤ 0.4 is moderate frailty, and FI > 0.4 is severe frailty. (Appendix2)

Patient will be followed after surgery.  All the in hospital complications should be noted and also the total length of stay including ward and ICU. Patients co morbid condition and the multiple drugs he is taking will be noted.