Exploring the Impact of Anesthesia on Postoperative Frailty Trajectories in Older Adults

Abstract

PURPOSE: Frailty is a dynamic perioperative condition influenced by anesthetic care; however, limited data exist on how anesthesia affects postoperative frailty trajectories. This scoping review examines the effects of perioperative anesthesia techniques on frailty trajectories in older surgical patients. SOURCES: We searched PubMed, ScienceDirect, the Directory of Open Access Journals (DOAJ), and Google Scholar for studies on preoperative and postoperative frailty assessments, along with anesthesia-related data, focusing on individuals aged 60 and older undergoing surgery. We extracted key information regarding frailty, anesthesia methods, study design, and patient characteristics. PRINCIPAL FINDINGS: A total of 34 studies were included, screening 41,313 records across 16 countries, with the majority originating from China (29.4%) and the United States (14.7%). Preoperative frailty was reported in 18.3%-43.9% of patients and was a strong predictor of negative postoperative outcomes, including mortality, delirium, prolonged ICU stays, and extended hospitalization. The evidence also suggests that the type of anesthesia and targeted perioperative management strategies-particularly regional anesthesia, multimodal approaches, and intraoperative hemodynamic control mechanisms-significantly improve postoperative frailty trajectories and cognitive outcomes. CONCLUSION: Frailty is a dynamic perioperative condition significantly influenced by anesthesia, rather than being merely a static preoperative risk indicator. This scoping review demonstrates that regional and multimodal anesthetic techniques can positively influence postoperative frailty trajectories and reduce neurocognitive decline, especially when combined with hemodynamic optimization. Therefore, integrated perioperative pathways, tailored anesthetic selection, and routine frailty screening have become essential for practicing surgeons and anesthesiologists. In the increasingly aging surgical population, we conclude that optimizing anesthesia care represents a crucial yet underutilized opportunity to maintain functional independence, reduce complications, and enhance long-term recovery.