Innovations in surgical management of frail elderly adults: an overview of current guidance and recent advances

Frailty is an important issue for surgeons as it is associated with worse outcomes following surgical intervention. With a progressively ageing global population, more frail elderly patients are undergoing surgical procedures. The recognition of frailty in clinical practice can be challenging, due to the complex interplay between physiological aging and multi-comorbidities which often co-exist in frail patients. The Centre for Perioperative Care (CPOC) and British Geriatric Society (BGS) published guidelines in 2021 to assist surgical teams with optimizing the management of frail patients in the perioperative period. This article directs surgeons through the guidelines at each checkpoint in the surgical care pathway, from preoperative risk stratification, to intraoperative approaches, and finally the postoperative period. Furthermore, we have discussed the challenges and latest innovations relevant to each of these pathway checkpoints that are promising to improve outcomes for frail surgical patients.