ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1636091
This article is part of the Research TopicInnovations and Strategies for Comprehensive Frailty Management in Older PeopleView all 15 articles
Frailty and Nutritional Assessments for Predicting Postoperative Complications in Older Adults Undergoing Non-Cardiac Surgery
Provisionally accepted
Sunisa Chatmongkolchart
Mantana Saetang*
Panalee Kittisopaporn
Thitikan Kunapaisal
Dararat YongsataKhwanrut Sukitpaneenit- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Frailty and malnutrition are closely linked to adverse surgical outcomes. However, their combined influence on post-non-cardiac surgery complications in older patients remains unclear. We aimed to evaluate the predictive value of frailty, malnutrition, and their combined effect on postoperative complications in older patients undergoing intermediate-to high-risk non-cardiac surgery. Methods: This study was a retrospective analysis of data from a prospectively collected cohort that included 637 patients aged ≥60 years. We assessed frailty using the Clinical Frailty Scale (CFS) and nutritional status using the Prognostic Nutritional Index (PNI). The primary outcome was the occurrence of postoperative complications (Clavien-Dindo classification ≥2). We used logistic regression and receiver-operating characteristic (ROC) analyses to determine the predictive accuracy of CFS, PNI, and CFS+PNI. Results: We identified frailty (CFS≥5) in 38.5% of patients, with 29.8% being malnourished (PNI<45). Multivariate analysis revealed that frailty independently predicted postoperative complications (odds ratio [OR]: 2.09, 95% confidence interval [CI]: 1.09-4.00; p=0.026). Severe malnutrition (PNI<40) exhibited a strong association with complications in univariate analysis (OR: 5.88, 95%CI: 3.13-11.08; p<0.001) but not in multivariate analysis. The combined CFS+PNI model showed enhanced discriminative ability (area under the curve [AUC]: 0.694, 95%CI: 0.647-0.740) compared with CFS (AUC: 0.619, 95%CI: 0.575-0.662) or PNI (AUC: 0.665, 95%CI: 0.618-0.712) alone. Conclusions: Frailty is a strong independent predictor of postoperative complications in older patients undergoing non-cardiac surgery. Although severe malnutrition correlates with increased risk, its effect may be partially mediated by frailty. The integration of frailty and nutritional assessments enhances postoperative complication prediction, underscoring comprehensive geriatric evaluation value in preoperative risk stratification.
Keywords: Clinical Frailty Scale, Malnutrition, older adults, Postoperative Complications, Prognostic nutritional index
Received: 27 May 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Chatmongkolchart, Saetang, Kittisopaporn, Kunapaisal, Yongsata and Sukitpaneenit. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mantana Saetang, Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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