ArticleBMC anesthesiology2026
Association between preoperative frailty and 30-day functional disability after surgery: a prospective cohort study using the Edmonton Frail Scale.
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFrailty is a known predictor of adverse surgical outcomes, yet its influence on functional recovery trajectories in South Asian settings remains underexplored. This study evaluated the association between preoperative frailty and achieving a clinically meaningful improvement in disability 30 days after elective surgery.
methodsA prospective cohort study was conducted at a tertiary hospital in Karachi, enrolling 146 patients aged > 50 years undergoing elective general or orthopedic surgery. Preoperative frailty was assessed using the Edmonton Frail Scale (EFS). Disability was measured using the WHODAS-12 at baseline and 30 days postoperatively. The primary outcome was a meaningful functional improvement, defined as a decrease of ≥ 3.5 points on the WHODAS-12 scale.
resultsAmong 146 patients (mean age 64.1 ± 9.4 years), 76.7% (n = 112) were categorized as frail. Frail patients had significantly higher baseline disability than non-frail patients (17.74 ± 6.70 vs. 12.29 ± 7.84; p < 0.001). At 30 days, overall disability improved significantly (mean change: −1.99 ± 8.12, p = 0.036), driven primarily by the frail group (− 2.66 ± 7.33, p = 0.007) compared to the non-frail group (+ 0.35 ± 10.34, p = 0.89). In the multivariable model, higher baseline WHODAS scores were significantly associated with a greater likelihood of improvement (OR 1.18 per point; 95% CI: 1.02–1.35; p = 0.022). Conversely, patients aged > 75 years were 89% less likely to achieve improvement (OR 0.11; 95% CI: 0.01–0.98; p = 0.048). Subgroup analysis indicated that improvement rates peaked in the Moderate frailty category (47.62%) compared to those classified as Vulnerable (12.50%).
conclusionPreoperative frailty identifies patients with the greatest potential for functional gain, though this recovery is significantly limited by advanced age. These results suggest that surgery provides a “functional dividend” for frail individuals with high baseline impairment. Routine frailty screening should be utilized to manage expectations and tailor recovery pathways in aging surgical populations.
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