Systematic review of the accuracy of the FRAIL scale for predicting postoperative complications in surgical patients

Background: Frailty is associated with increased risk for postoperative complications and mortality. During the COVID-19 pandemic, many preoperative assessments have shifted to telehealth assessments, precluding the use of frailty tools that require in-person assessment. The FRAIL scale is a brief (5-item) assessment that can be conducted via telehealth or self-report;however, its accuracy to predict postoperative complications in older surgical patients is unclear. We performed a systematic review of the accuracy of the FRAIL scale1 to predict postoperative complications in older surgical patients. Methods: A search strategy was conducted within Medline, Scopus, Web of Science, and Cochrane databases from 2011 to May 4th, 2021. A backwards citation search was built identifying studies that cited the validation study1. The search terms included surgical or perioperative care, elderly, and FRAIL scale. Studies not reporting mortality, postoperative complications, functional outcomes, length of stay (LOS), or case reports, case studies and non-English publications were excluded. All stages of the review were completed by two reviewers. The primary outcome was mortality, and secondary outcomes included functional outcomes, LOS, and postoperative complications. Risk of bias was assessed via the QUIPS tool. Results: A total of 3,049 studies were identified (Fig.1). Fifteen studies (n=3592)were included in the final review. Four of the 7 studies reporting mortality as a primary outcome, found associations with frailty defined by FRAIL score (>2). Three studies showed frail patients more likely to experience longer LOS, four showed worse functional recovery, and five showed greater likelihood to develop post-operative delirium or complications. Only six of the studies used a comparator with the FRAIL scale. Fourteen studies had low risk of bias. Conclusion: There is prognostic value for the FRAIL scale as it is associated with negative postoperative outcomes.