Frailty Screening and Multidisciplinary “Surgical Pause” Can Define Who Proceeds to Surgery or Alternatives

Baldacchino MM, McQuestion CC, Giuca MS, et al. The Use of Frailty Scores for Screening the Surgical Risk–Benefits: A Multidisciplinary Approach. Ann Surg. February 2026. 

This article examines a single-center VA cohort (2011–2023) of 388 frail surgical candidates screened with the Risk Analysis Index (RAI) and reviewed by a Multidisciplinary Surgical Pause Committee (MDSPC). 

Patients were assigned to one of four pathways: proceed as planned (G1), proceed after medical optimization (G2), modify to less invasive surgery or anesthesia (G3), or nonsurgical management (G4). Mean RAI increased with treatment conservatism: 36.4 in G1, 37.4 in G2, 41.4 in G3, and 44.2 in G4. 30-day mortality ranged from 6.6% in G1 to 19.8% in G4, and 1-year mortality was similar for G1 and G2 at approximately 33% to 35%, but it was higher in G3 and G4 at approximately 51% to 56%. Average survival favored G1 and G2, approximately 35 months, versus 20 and 18 months in G3 and G4, respectively. The authors report RAI thresholds of 40.5 for prohibiting surgery in practice and 42.5 for predicting 1-year mortality in this cohort.

Implications are pragmatic for surgeons. Routine frailty screening with the RAI is a strong triage signal for MDSPC referral and pathway selection. Medical optimization before surgery produced 1-year survival comparable to immediate operation, whereas step-down to less invasive plans conferred only a short early survival advantage and converged with nonsurgical management by 12 months.

Surgeons should use the MDSPC to set expectations, plan perioperative optimization, and define when a less invasive operation is meaningfully safer versus when medical management is preferable.