Frailty assessment scales for perioperative prognosis in pancreaticoduodenectomy

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.

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