Frailty as a determinant of decision-making in emergency surgery in the older patient

Frailty is a multidimensional condition associated with reduced physiological reserve and greater vulnerability to adverse events in older patients undergoing emergency surgery. In this context, its identification may contribute not only to prognostic stratification but also to the individualization of therapeutic decision-making. The objective was to analyze the available evidence on frailty as a determinant of decision-making in emergency surgery in the older patient. This is an integrative literature review, descriptive in nature and qualitative in approach, conducted in the PubMed/MEDLINE, LILACS and SciELO databases, covering publications from January 2020 to September 2026. Descriptors and free-text terms related to frailty, the older population, emergency surgery and decision-making were used, combined using the Boolean operators AND and OR. Studies addressing older patients, frailty and surgery or decision-making in an emergency setting, published in Portuguese, English or Spanish, were included. The evidence demonstrated an association between frailty and higher mortality, postoperative complications, prolonged hospitalization, readmission, need for rehabilitation and loss of independence. In addition to its prognostic value, frailty assessment showed relevance to the individualized weighing of the risks and benefits of intervention, considering functional status, prognosis, goals of care and patient preferences. It is concluded that frailty constitutes an important determinant of decision-making in emergency surgery in older patients and should be integrated into clinical assessment, without being considered in isolation as a contraindication to surgical intervention.