To the Editor The interesting study by Shinall et al1 used a novel operative stress score to classify surgical interventions by the amount of physiologic stress imposed on a patient. Irrespective of a procedure’s operative stress score, the authors established that patients who are deemed either frail or very frail, based on the Risk Analysis Index, have increased rates of postoperative mortality across all procedures. This work revealed that all procedures are essentially high risk for frail patients and that frailty screening should be universally implemented to more accurately predict postoperative mortality. While screening would serve to identify at-risk patients, how do we importantly improve outcomes for frail patients? A potential solution is prehabilitation.2
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Sell NM, Qadan M, Silver JK. Implications of Preoperative Patient Frailty on Stratified Postoperative Mortality. JAMA Surg. 2020;155(7):669–670. doi:10.1001/jamasurg.2020.0430
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