Subjective assessment
As part of the routine evaluation of patients prior to surgery, patients were clinically assessed by two experienced clinicians (RGD and IRA) to determine frailty and fitness for surgery. The clinical evaluation included the detailed collection of a patient-specific medical history. This clinical determination aimed to answer the question “Is this patient attending for clinical assessment today fit enough for the proposed surgical procedure?” Each patient was judged to be either ‘frail’ or ‘not frail’ after the initial meeting, and this was supplemented with “fit” or “not fit” from careful review of their medical notes. Patients were also graded according to the American Society of Anaesthesiologists (ASA) grading criteria11whereby a healthy patient is ASA I, a patient with mild systemic disease is ASA II, a patient with severe systemic disease is ASA III, ASA IV refers to a patient with life‐threatening severe systemic disease and ASA V to a moribund patient.