title: The implication of frailty on preoperative risk assessment.
abstract: OBJECTIVE
  Frailty, a state of decreased homeostatic reserve, is characterized by dysregulation across multiple physiologic and molecular pathways. It is particularly relevant to the perioperative period, during which patients are subject to high levels of stress and inflammation. This review aims to familiarize the anesthesiologist with the most current concepts regarding frailty and its emerging role in preoperative assessment and risk stratification.
  
  
  RESULTS
  Current literature has established frailty as a significant predictor of operative complications, institutionalization, and death among elderly surgical patients. A variety of scoring systems have been proposed to preoperatively identify and assess frail patients, though they differ in their clinical utility and prognostic ability. Additionally, evidence suggests an evolving potential for preoperative intervention and modification of the frailty syndrome.
  
  
  CONCLUSIONS
  The elderly are medically complex and heterogeneous with respect to operative risk. Recent advances in the concept of frailty provide an evidence-based framework to guide the anesthesiologist in the perioperative management, evaluation, and risk stratification of older surgical patients.
authors.affiliation: aDepartment of Anesthesiology bDepartment of Neurosurgery cDepartment of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Levana G
authors.initials: LG
authors.lastname: Amrock
authors.forename: Stacie
authors.initials: S
authors.lastname: Deiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*