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Background and Aims In elderly patients undergoing surgery frailty can lead to adverse perioperative outcomes. The present study aimed to evaluate the diagnostic accuracy of ultrasound (USG) measurements of rectus femoris (RF) and quadricep muscle in discriminating frailty in elderly patients and to assess their predictive ability for perioperative outcomes

Methods In this prospective observational study, we enrolled 87 elderly patients who were scheduled to undergo elective surgeries under anaesthesia. In the preoperative period, frailty was assessed by the Clinical Frailty Score. Preoperative USG measurements of the RF and quadricep muscles were obtained. These measurements were standardized for different body habitus and gender. Patients were followed up to 30 days after surgery and the perioperative clinical outcomes such as the occurrence of complications, intensive care admission, and mortality were noted.

Results A total of 87 patients were enrolled for participation in the present study out of which 6 were lost to follow-up. Using the Clinical Frailty Scale (CFS), we found that out of 81 patients, 28 were non-frail and 53 patients were frail. There was a statistically significant difference in the USG parameters between frail and non-frail patients. We found that USG parameters have good diagnostic ability for frailty (AUC=0.7) and when these were adjusted for the body surface area their diagnostic ability increased (AUC=0.8). However, the USG parameters have fair accuracy for predicting postoperative clinical outcomes ( AUC 0.6 to 0.7).

Conclusions USG measurement of thigh muscles in preoperative patients may be used as a marker for frailty to predict their clinical outcomes after surgery.