Frailty and Upper Gastrointestinal Surgery: Initial Findings from Thailand’s First Surgical Frailty Study

Abstract

Objective: Thailand’s aging population has led to an increase in elderly patients undergoing major surgery. Frailty is a key predictor of adverse surgical outcomes, but its impact in Thai patients remains underreported. This study aimed to determine the prevalence of frailty and its association with short-term postoperative outcomes among patients undergoing upper gastrointestinal (UGI) surgery. Materials and Methods: This prospective cohort study included all adult patients undergoing elective UGI surgery at Siriraj Hospital between May 2020 and November 2021. Preoperative frailty was assessed using the Thai Frailty Index (TFI), with scores >0.25 indicating frailty. Demographic data, surgical details, and postoperative outcomes — including complications and survival at 3, 6, and 12 months — were compared between frail and robust groups. Results: Among 56 patients (median age 61.5 years), 18 (32.1%) were classified as frail. Frail patients were significantly older and had poorer functional status and nutritional risk. Frail patients also underwent fewer resection procedures (61.1% vs 84.2%, p=0.001). While the overall complication rate did not differ significantly between groups (50.0% vs 47.4%; p=0.457), frail patients experienced higher rates of major complications (16.7% vs 10.5%; p=0.045) and non-surgical complications (33.3% vs 21.1%; p=0.044). Mortality was significantly higher in the frail group at 3, 6, and 12 months postoperatively (p=0.001, 0.003, 0.006 respectively). Conclusion: Frailty is common among Thai patients undergoing UGI surgery and is associated with worse short-term outcomes and higher postoperative mortality. Routine frailty screening using the TFI may improve preoperative risk stratification and perioperative care planning.