Preoperative Frailty Screening and Risk Prediction Model in Elderly Patients Undergoing Hepatectomy: A Cross-Sectional Study.

PURPOSE: This study aimed to develop and evaluate a preoperative frailty screening and risk prediction model in elderly patients undergoing hepatectomy.

PATIENTS AND

METHODS

In this prospective observational study with a cross-sectional baseline assessment, we included 216 elderly patients aged ≥60 years who underwent liver resection at a tertiary hospital in Guangdong Province from January 2024 to September 2025. We collected patients' data from their frailty assessments, preoperative clinical marker evaluations, and their demographic characteristics. Subsequently, univariate and multivariate binary logistic regression analysis was employed to identify factors associated with frailty status.

RESULTS

Among 216 elderly patients undergoing hepatectomy, 164 (75.9%) were classified as non-frail, 40 (18.5%) as pre-frail, and 12 (5.6%) as frail, with 24.1% exhibiting frailty (FRAIL score ≥2). Univariate analysis identified 13 clinical indicators significantly associated with frailty status (p < 0.05). Multivariate binary logistic regression analysis demonstrated that older age, higher ASA classification, and elevated NRS-2002 score were independent risk factors for frailty, whereas higher metabolic equivalent (MET) levels and higher albumin concentrations were protective factors. The prediction model showed excellent apparent discrimination (AUC = 0.923) and good calibration; however, further validation is required before routine clinical implementation. Furthermore, frailty was significantly associated with longer postoperative and total length of stay, as well as a higher rate of unplanned reoperation.

CONCLUSION

Preoperative frailty status in elderly patients undergoing liver resection was associated with multiple clinical indicators. However, the proportion of patients with overt frailty among those undergoing surgery was low (5.6%), suggesting the crucial need for rigorous clinical screening. Hence, perioperative management should be prioritized for patients with pre-frailty, and an individualized treatment decision-making system should be established for those with severe frailty.