Decision Making of Surgical Strategy in Older and/or Frail Persons

The aging population poses significant challenges to surgical practice, as increasing numbers of older adults require interventions for various abdominal conditions. Traditional approaches based solely on chronological age are no longer adequate for assessing surgical risk in this population. Instead, frailty—a multidimensional syndrome of physiological decline—has emerged as a key predictor of outcomes, surpassing chronological age in determining mortality, morbidity, and postoperative recovery. This review highlights the importance of frailty assessment in older surgical patients, particularly for emergency and major abdominal surgeries such as colorectal, liver, pancreatic, and gastric procedures. Comprehensive Geriatric Assessment (CGA) and frailty indices like the Clinical Frailty Scale provide valuable tools to guide treatment decisions. Evidence shows that frailty is associated with higher rates of complications, longer hospital stays, and diminished functional recovery. Tailored approaches, including multidisciplinary team involvement and minimally invasive techniques, are essential to optimize outcomes and maintain quality of life. This review underscores the critical need for individualized treatment strategies and further research into the applicability of emerging surgical and nonsurgical approaches in frail elderly populations. By integrating frailty assessments into clinical practice, surgeons can make informed decisions that align with patient goals, improving both survival and postoperative quality of life in this vulnerable population.