accompany aging, results in increased risk of drug toxicity in the setting of anesthesia and chemotherapy.2–3


Measuring frailty Frailty is defined as a multidimensional syndrome associated with aging that includes decreased physiological abilities and increased vulnerability to stressors.


There are two widely accepted approaches to conceptualizing and measuring frailty: The frailty phenotype and the deficit- accumulation frailty index (FI).4–5


In the phenotypic model described by Fried et al,6


derived from the


Cardiovascular Health Study (CHS), the presence of frailty is determined on the basis of five physical indictors:


• Unintentional weight loss • Exhaustion • Weakness • Slow walking • Low physical activity


Variations of this model have been developed in specific patient populations. For example, the performance-based Liver Frailty Index (LFI), which measures grip strength, chair standing and balance testing, was specifically developed to assess frailty in cirrhotic patients.7


Among


transplant candidates, frailty as measured by the LFI has demonstrated to be more predictive of waitlist mortality than the Model of End-stage Liver Disease (MELDNa) alone and more predictive of poor health and higher risk of acute cellular rejection post–liver transplantation.6–7


The FI model developed by Rockwood et al in the Canadian Study of Health and Aging (CSHA) conceptualizes frailty as a cumulative measure of medical, social and functional deficits over time.8 The original frailty index included 70 individual variables, with subsequently validated modified frailty indices (mFI) mapping the original frailty index to 11 and then five variables including:8


• Congestive heart failure • Diabetes mellitus


• Chronic obstructive pulmonary disease or pneumonia


Frailty is emerging as an important determinant of healthcare and surgical outcomes in the elderly population and is increasingly being considered to guide treatment decisions across medical and surgical specialties.


• Partially dependent or totally dependent functional health status


• Hypertension requiring medication


These patient-specific factors are documented in the National Surgical Quality Improvement Program (NSQIP) database, allowing for large-scale retrospective studies across surgical disciplines to assess the impact of frailty as captured by the mFI on postoperative outcomes. Unfortunately, the absence of a high-quality data registry in IR that includes validated frailty metrics poses a significant barrier to frailty research in our specialty.


Frailty and healthcare outcomes Over the past decade, frailty has emerged as a clinically salient entity for predicting general adverse health outcomes in the geriatric population. In many studies, frailty is found to be independently predictive of incidental falls, functional disability, hospitalization, morbidity and mortality.9


In the surgical realm,


pre-operative frailty has proven to be a robust metric for predicting adverse surgical outcomes such as postoperative infection, prolonged hospitalization, discharge to skilled nursing facility and mortality. Across surgical specialties, frailty assessment routinely outperformed many of the conventional surgical risk stratification tools such as American Society of Anesthesiologists (ASA) classification, Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score and Eastern Cooperative Oncology Group (ECOG) performance status. Frailty has been demonstrated to be predictive of adverse outcomes in endovascular interventions in the fields of cardiology and vascular surgery, and predictive of surgical complications, radiation and chemotherapy intolerance and disease progression in cancer patients.10–13


While these specialties


share surgical techniques similar to those of IR and have overlapping patient population, data on the prevalence of frailty among IR patients


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