Date of this Version

11-25-2025

Document Type

DNP Project

Rights

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Abstract

Background: In January 2025, the American Society of Anesthesiologists (ASA) issued a practice advisory with evidence-based recommendations for caring for older adults preparing for inpatient surgery, emphasizing independence as the ultimate goal. Frailty, a major contributor to postoperative decline, complications, and extended hospital stays, is a growing concern as populations age. Current preoperative evaluations often rely on subjective tools such as the ASA physical status classification score, which does not consider frailty. This project evaluates the integration of the Clinical Frailty Scale (CFS) into preoperative workflows for surgical patients aged 65 and older to improve risk stratification and outcomes. An online education module was created for anesthesia providers on the use of the CFS, followed by its importance during routine preoperative assessments to compare its effectiveness against the ASA score alone.

Methods: PubMed, Google Scholar, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) search engines were accessed via the Florida International University (FIU) library database to compose a comprehensive search for peer-reviewed research studies within the last 10 years that examined the risk of frailty for elderly patients undergoing surgery and how to better care for this patient population. Provider feedback and patient outcomes were analyzed using pre- and post-test surveys via Qualtrics to determine the feasibility and clinical impact of the tool.

Results: The adoption of frailty assessments revealed a significant reduction in morbidity and mortality rates among frail patients compared to reliance on the ASA score alone. Key associations included reduced intensive care unit (ICU) admissions, shortened hospital stays, and fewer postoperative complications. The survey demonstrated improved knowledge and attitudes among certified registered nurse anesthetitists (CRNAs) regarding frailty following the educational module. Participants reported greater confidence in identifying frailty and expressed increased willingness to incorporate standardized frailty assessments into preoperative evaluations, highlighting the effectiveness of the intervention in influencing practice readiness.

Discussion: Integrating frailty assessments significantly enhanced preoperative risk stratification, highlighting the limitations of traditional tools like the ASA score. Findings align with existing literature emphasizing the utility of frailty assessments in surgical planning. However, barriers to implementation, including time constraints and lack of standardization, remain. Overall, the results highlight that incorporating frailty screening allows for more precise risk stratification than the ASA score alone, ultimately optimizing care for elderly surgical patients.

Conclusion: Routine use of frailty assessments in elderly surgical patients optimizes perioperative care and improves outcomes. Standardizing these tools in clinical practice is imperative for addressing the unique vulnerabilities of this population. Future research should focus on refining frailty tools for broader adoption and exploring long-term outcomes.

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