Frailty is a common geriatric syndrome associated with reduced physiological reserve and
increased vulnerability to surgical stress. As the population ages, more older adults
undergo major elective surgery, yet frailty is often insufficiently assessed in routine
practice and no universally accepted screening tool exists.
The Essential Frailty Toolset (EFT) is a simple validated frailty assessments and has
demonstrated strong predictive value for mortality and major postoperative complications,
particularly in cardiac surgery populations. EFT incorporates four key domains of
cognition, anemia, serum albumin, and physical function capturing both physical and
cognitive vulnerability. A modified version (mEFT) has been developed to improve
feasibility and applicability in broader surgical settings, requiring minimal training
and only a few minutes to administer. Despite its promise, mEFT has not been evaluated in
elderly patients undergoing major elective non-cardiac surgery, representing an important
gap in the current literature and motivating the present study.
We therefore propose a modified and simplified frailty screening tool tailored for
elderly patients undergoing major elective non-cardiac surgery at our institution. The
modified Essential Frailty Toolset (mEFT) is a multi-dimensional assessment designed to
address this gap by evaluating physical function, cognition, nutrition, and anemia in
just a few minutes. In this version, the tool assigns points based on specific clinical
markers: the Timed Up and Go (TUG) test provides one point for a time ≥11.0 seconds and
two points for ≥15.0 seconds; the Clock Drawing Test (CDT) provides one point for a score
of ≤2 on a 3-point scale; nutritional risk is captured with one point for a BMI <22.0 or
unintentional weight loss of 5% over the last six months; and anemia provides one point
based on hemoglobin levels (below 130g/L for men and 120 g/L for women). These
modifications were made to enhance feasibility and clinical relevance in our population.
Low serum albumin was rare in our cohort and therefore demonstrated limited
discriminatory value as a screening marker. In contrast, low BMI and recent weight loss
are well-established risk factors for malnutrition and sarcopenia and are readily
obtainable in routine preoperative assessment. Similarly, both the TUG and CDT are quick,
inexpensive, and require minimal training, making them well suited for large-scale
screening in preoperative clinics.Importantly, the proposed components have been
evaluated in a pilot study conducted in our institution.
This study will evaluate whether a high mEFT score (≥3) is associated with increased
postoperative complications and 90-day readmissions among patients aged ≥70 years
undergoing major elective surgery. Patients presenting for admission will be included. If
mEFT accurately identifies high-risk patients, it may improve preoperative risk
stratification, inform shared decision-making, and help identify individuals who could
benefit from targeted prehabilitation, supporting broader implementation of frailty
screening in surgical care.
