Messenger of Anesthesiology and Resuscitation · Jun 24, 2026

Frailty assessment scales for perioperative prognosis in pancreaticoduodenectomy

By Егоров ВИ, Kotelnikov AG, Rakhmatullin BF et al.

Pancreaticoduodenectomy (PD) is associated with high rates of postoperative complications (30–50%) and mortality (2–5%), while traditional risk factors do not adequately reflect a patient’s functional reserve. Frailty assessment is considered a promising approach for perioperative prediction. This review analyzes 35 publications (2014–2025) on frailty scales in patients undergoing PD. The most studied tools were the modified frailty index (mFI-11 and mFI-5), Clinical Frailty Scale (CFS), Edmonton Frail Scale (EFS), Comprehensive Geriatric Assessment (CGA), Risk Analysis Index (RAI), and Fried frailty phenotype. CFS showed the strongest association with mortality (OR 4.89; 95% CI 1.83–13.05), EFS with postoperative complications (OR 2.93; 95% CI 1.52–5.65), and the Fried phenotype with postoperative delirium (OR 3.79). mFI-5 > 2 was associated with increased mortality (OR 2.08) and reduced median overall survival (21.3 vs 42.1 months). mFI-11 > 0.27 was an independent predictor of complications (OR 1.544) and 30-day mortality (OR 1.536). However, the key finding is low sensitivity of all scales: in a comparative study of seven instruments, sensitivity ranged from 21.5% to 38.5% with specificity of 76.7–92.4%. In the largest PD cohort (n = 9986), frailty by mFI ≥0.27 was detected in only 6.4% of patients – 4–6 times lower than the expected prevalence. RAI-C at threshold ≥21 had sensitivity 0.50, RAI-A – 0.25. Thus, existing scales miss 60–80% of frail patients (especially those with prefrailty), raising doubts about their clinical utility as standalone screening tools. The strongest association with mortality was achieved for CFS, with complications – for EFS, with survival – for mFI-5. Given the low sensitivity, the most reasonable strategy is to perform extended geriatric assessment in all patients aged 65–70 years or older without prior screening, who will undergo PD.

doi.org/10.24884/2078-5658-2026-23-3-134-144Open accessBiomarkers