International Journal of Anesthesiology Research · Jul 2026

Frailty Score Combined with Regional Anesthesia for Predicting Postoperative Delirium in Elderly Orthopedic

By Khan MA, Gupta SL, Patidar P

Background: Frailty is an important determinant of vulnerability to postoperative complications in older adults. Postoperative delirium (POD) is common after orthopedic surgery and is associated with prolonged hospitalization, functional decline and increased morbidity. Regional anesthesia may reduce exposure to general anesthetic agents, but its effect on delirium is not uniform. A combined assessment of baseline frailty and perioperative anesthesia strategy may improve identification of patients at high risk for POD. Objective: To evaluate the association between preoperative frailty and postoperative delirium in elderly orthopedic patients receiving regional anesthesia, and to assess whether a frailty score can predict POD. Methods: This prospective observational cohort study is designed to enroll patients aged ≥65 years undergoing elective or urgent orthopedic surgery with a regional anesthesia-based anesthetic plan. Frailty will be assessed preoperatively using the Clinical Frailty Scale (CFS), with delirium assessed postoperatively using the Confusion Assessment Method (CAM) at predefined time points. Demographic, surgical, anesthetic and perioperative variables will be recorded. Multivariable logistic regression will evaluate the independent association between frailty and POD. Illustrative results: In a simulated cohort of 100 patients, postoperative delirium occurred in 4% of robust, 14% of pre-frail and 31% of frail patients. Frailty was associated with an increased estimated odds of POD after adjustment for age, comorbidity burden and preoperative cognitive vulnerability. Conclusion: Preoperative frailty assessment may provide a simple and clinically useful method for identifying elderly orthopedic patients at increased risk of POD despite the use of regional anesthesia. A combined frailty-informed perioperative pathway may support targeted delirium-prevention strategies.

doi.org/10.33545/26648849.2026.v8.i2a.96Open accessBiomarkers