Frailty in the over 65’s undergoing elective surgery (FIT-65) – a three-day study examining the prevalence of frailty in patients presenting for elective surgery
Authors: Harrison Sarah , Harvie David A. , Wensley Frances , Matthews Lewis ,   Southcoast Perioperative Audit, Research Collaboration (SPARC), Denehan William , Barlow Ciaran , Ding Davina , Green Dylan , Grace Emma , Read Joseph , Houghton Kerensa , Towell Charlotte , Gupta Neha , Cummin Oliver , Sivasubramanian Ramayee , Fahmy Alex , Cumpstey Andrew , Todd Anna , TrembickijRose Gabor Jessica , Bracegirdle Luke , Vohra Shiv , Williams Simon , Beeby Sophia , Patel Mitul , Dawe Victoria , Collis James , Tyller-Veal Chris , Ellis Sophie , Lee Robyn , McGovern Vincent , Williams Rachel , McEwan Samantha , Derby Emma , Saxena Oshine , Van Der Schyff Victoria , Kirkham Fiona , Kirby Stephanie , Sandberg Charlotte , Philips Charlotte , Sharvill Rory , Vora Chintan , Sands Becky , Smart Becky , Maynard Jack , Fung Anthony , Elliot Kate , Bhattacharjee Samuel , Orr Siobhan , Hamilton Alexander , Stafford Nicholas , Greenwood Amy , Penn Charlie , Aswath Avinash , Massingberd-Mundy David , Bailey Jessica , Davies Miranda , Eddie Michael 
Published: August 2022

Abstract
Background
Frailty increases the risk of perioperative complications, length of stay, and the need for assisted-living after discharge. As the UK population ages the number of frail patients presenting for elective surgery in the UK is likely to grow. Despite the potential benefits of early diagnosis, frailty is not uniformly screened for in UK elective surgical patients and its prevalence remains unclear. The primary aim of this study was to assess the prevalence of frailty in patients aged over 65 years undergoing elective surgery.

Methods
We performed a prospective cross-sectional observational study in eight UK hospitals. Data were collected over three consecutive days with follow-up at 30 days. HRA approval was obtained (REC 20/SC/0121) and signed informed consent obtained. Participants were eligible for inclusion if they were 65 years or older and undergoing elective surgery. Pre-operative data were collected from hospital notes by anaesthetic trainees. A member of the research team blinded to the pre-operative dataset screened each participant for frailty pre-operatively using the Reported Edmonton Frail Scale (REFS). Post-operative data were collected from the notes on day of surgery and at 30 days. Participants were defined as “frail” if they scored 8 or more on the REFS.

Results
Two hundred twenty eight participants were recruited during the study period of whom 218 proceeded to surgery. There were 103 females and 115 males. Median age was 75 years (interquartile range 70–80). Thirty-seven participants (17.0%) were identified as frail. Frail patients were older, had a higher ASA score, were more likely to have carers and were more likely to be anaemic or present with ECG abnormalities. There were no differences in gender, BMI, place of residence or smoking status for patients identified as frail versus non-frail. There was no difference in length-of-stay between frail and non-frail patients, although those identified as frail were less likely to be discharged to their own home.

Conclusion
We found the prevalence of frailty in a mixed population of elective surgical patients aged 65 or over to be 17.0%. Furthermore, we found the REFS to be a practical tool for pre-operative frailty screening. Frail patients presented for elective surgery with modifiable co-morbidities which could have been optimised pre-operatively. Early screening could highlight frail patients, allowing time for pre-operative planning and evidence-based optimisations of comorbidities. We therefore encourage the adoption of frailty assessment as a routine part of pre-operative assessment.