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Frailty is defined as ";a clinically identifiable state of diminished physiologic reserve and increased vulnerability to a broad range of adverse health outcomes.";1 Frailty has been associated with poor outcomes, morbidity, and mortality in surgical patients.2-7 A quality improvement project implemented by the surgical residents identified that surgeons accurately identified their surgical patients as frail approximately 50% of the time when frailty was assessed by grip strength. Surgeons'; subjective assessment of frailty has been previously reported as having a poor associated with objective frailty. For example, 82% of frail geriatric thoracic surgery patients had degrees of frailty that were undetected by nongeriatric teams.8 In addition, surgeon';s subjective assessment of frailty is biased; older age, female sex, and non-Caucasian race were associated with higher subjective frailty scores.9 There are several tools that have been validated to measure frailty including the Risk Analysis Index (RAI), the Tilburg test, and grip strength. The Risk Analysis Index (RAI) is a validated, 14-item frailty screening tool designed to objectively quantify a patient';s physiologic reserve by assessing specific deficits across domains such as age, sex, malignancy status, comorbidities (e.g., renal failure, congestive heart failure), functional status, and cognition.10 The Tilburg Frailty Indicator (TFI) is a questionnaire designed to screen for frailty in community-dwelling older adults, adopting an integrated, multidimensional approach rather than focusing solely on physical phenotype.11 Grip strength acts as a rapid, non-invasive biomarker for overall physiologic reserve and is a central component of the physical frailty phenotype.12 It serves as a quantifiable proxy for sarcopenia and neuromuscular integrity.13 Frailty assessments have been implemented to predict postoperative outcomes. In addition, surgeons have proposed prehabilitation prior to elective surgery in order to reduce postoperative morbidity. There are currently multiple ongoing multicenter randomized control trials evaluation the effects of prehabilitation (including physical strengthening, respiratory training, nutritional support, and therapy and psychosocial treatment) of frail patients prior to scheduled surgery.14-16 To date, there are no conclusions about the effects of prehabilitation on postoperative outcomes. The aim of this study is to assess frailty in surgical patients before and after surgery in order to compare the objective frailty assessment with the surgeon';s perceived patient frailty as well as compare postoperative complications. We hypothesize that surgeons cannot accurately assess frailty in patients and that frail patients have more postoperative complications compared to their robust counterparts. Future directions will aim to develop of a multimodal prehabilitation program at UConn Health Center in order to improve postoperative outcomes in frail patients.
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