Background: To compare the predictive power of three different evaluation methods of frailty for 90-day outcomes of elderly patients undergoing elective abdominal surgery. Methods: A prospective cohort study was conducted with 194 patients and a postoperative follow-up period of 90 days. Preoperative frailty was evaluated using the five-item FRAIL questionnaire, 54-item frailty index (FI), and nine-item Clinical Frailty Scale (CFS). Receiver operating curves were used to compare the predictive ability for 90-day mortality and long-term hospitalization (LTH), and logistic regression was used to calculate odds ratios and 95% confidence intervals. Results: The incidence rates of frailty assessed using FRAIL, FI, and CFS criteria were 43.8%, 32.5% and 36.6%, respectively. The 90-day mortality and LTH of frail patients were significantly higher than those of non-frail patients regardless of which criteria were used. The CFS and FI predicted 90-day mortality better than FRAIL (CFS versus FRAIL: P = 0.005; FI versus FRAIL: P = 0.041), and the CFS predicted LTH better than FRAIL (P = 0.032). Conclusions: Patients diagnosed with frailty had significantly higher 90-day mortality and LTH regardless of which criteria were used. The CFS and FI were better predictors of 90-day mortality, and the CFS was a better predictor of LTH.

Purpose To determine which frailty method can better improve the predictive ability of the Surgical Apgar Score combined with American Society of Anesthesiologists physical status classification (SASA). Patients and Methods A prospective cohort study was conducted. A total of 194 elderly patients undergoing elective abdominal surgery were included. Preoperative frailty using FRAIL questionnaire, frailty index (FI), Clinical Frailty Scale (CFS) and SASA scores was assessed. Primary outcome was in-hospital Clavien-Dindo ≥grade II complications. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves were used to explore the predictive ability of frailty. Results According to the FRAIL, FI and CFS criteria, the prevalence of frailty in the study population was 43.8%, 32.5%, and 36.6%, respectively. After adjusting for all covariates, frailty was significantly associated with postoperative complications in hospital by FRAIL [odds ratio: 5.11, 95% CI: 1.41–18.44, P = 0.013], by FI [OR: 4.25, 95% CI: 1.21–14.90, P = 0.024] and by CFS [OR: 5.10, 95% CI: 1.52–17.17, P = 0.008]. The area under the curve (AUC) for SASA was 0.768 (95% CI: 0.702–0.826). Addition of frailty assessment (FRAIL, FI and CFS) increased the AUC to 0.787 (95% CI: 0.722–0.842), 0.798 (95% CI: 0.734–0.852), and 0.815 (95% CI: 0.753–0.867), respectively. Compared to SASA, only addition of CFS had a significant difference ( P = 0.0478). Conclusion Frailty is an effective predictor of postoperative complications in elderly Chinese patients undergoing elective abdominal surgery. Frailty assessment of CFS can better improve the predictive ability of SASA.