Correlation between clinical assessment of frailty and preoperative point of care USG assessment of muscle mass in the elderly surgical population undergoing elective surgery - a Prospective Observational Study

Frailty is the decline in physical and cognitive reserves leading to increased vulnerability to stressors such as surgery or disease states. The frail phenotype is associated with a decreased status in mobility, muscle mass, nutritional status, strength, endurance and is associated with post-surgical adverse outcomes and increased risk of mortality as compared to their fit or resilient counterparts.

Many frailty assessment tools have been created to help us identify these at-risk patients. The  Clinical Frailty Scale(CFS) utilizes 9 components to assess frailty and  focuses on items that can be readily observed without specialist training, including mobility,  balance and use of walking aids and the abilities to eat, dress, shop, cook, and bank. However, it is only a subjective assessment of frailty.

The Fried frailty (1) index which is a more objective measurement, characterizes frailty in five different domains (weight loss, exhaustion, weakness, slowness, and physical activity levels). Although extensively validated the assessment may be too time-consuming to perform in a preanaesthetic setting and was not created to risk-stratify preoperative patients.

In the perioperative setting, a frailty tool that can be applied when a patient is not able to walk due to an acute or chronic disease process or unable to provide a comprehensive medical history due to altered mental status is necessary. Use of conventional scales can be challenging.

Sarcopenia, or skeletal muscle loss which is a biologic and functional marker of frailty has been objectively quantified by using computed tomography (CT) to identify frailty in their surgical populations (2). However, computed tomography is expensive, resource-intensive and exposes patients to radiation. Therefore, unless the patient needs a preoperative CT scan as part of standard of care for their diagnostic work-up, it is not an optimal diagnostic tool of frailty.

Recently, Point of care ultrasound (POCUS) has been used to discriminate between frail and non-frail patients before surgery and in Intensive care units by measuring Quadriceps, rectus femoris, Psoas depth , thickness (3)  and cross sectional area .

We hypothesize that Point of Care Ultrasound (POCUS) measurement of Quadriceps Depth, Rectus Femoris cross-sectional area and circumference will correlate well with clinical assessment of frailty.