Frailty in surgery

segment is the segment of people older than 85 years. 2 Given these changing population demographics, it has become imperative for health care professionals to integrate the understanding of the physiology of aging in their clinical practice. In recent years, there has been an increase in number of elderly patients presenting to hospital with a disease state requiring operative intervention. 3 In fact, the aging population is responsible for more than half of the total number of surgeries performed in the United States. 3 Since most older adults have one or more chronic conditions, are taking several medications, and frequently experience functional impairments, surgeons are performing operations on patients who are older and sicker, with complex health care needs. Clues about the patients’ physiologic reserve, their vulnerability to intraoperative or postoperative complications, and their short- and long-term prognoses are invaluable. However, neither the rate nor the extent of decline in physiologic function among aging is uniform. Heterogeneity that exists among aging individuals is based on their individual physiologic reserve, that is, the amalgamation of intrinsic host factors such as age, sex, nutritional status, functional capacity, hormonal balance, and any preexisting medical conditions that might increase their morbidity and mortality after stressful events. 4 This has given rise to the concept of ‘‘frailty’’ and its operational counterparts, ‘‘the frailty index’’ (FI) and ‘‘frailty scores’’ (FS). The concept of frailty is well established in the geriatric literature; however, the implementation of this concept in surgery is still evolving. In this article, we review the relevance of the concept of frailty in surgery, especially its role in identifying vulnerable surgical patients, improving patient care, and decreasing hospital costs. In addition, we have tried to simplify the concept of frailty and FI to expand the spectrum of its understanding and application.