The Clinical Frailty Scale (CFS) is a scoring tool used by clinicians to quantify the degree of frailty in patients. Previous research has demonstrated a correlation between high CFS scores and poor patient outcomes, underpinning its relevance in providing care for the ageing population. [1] The CFS is a 9-point system scaled from 1 (very fit) to 9 (severe frailty with terminal illness) A person with a score of ≥ 5 is considered frail. [2]

Frailty is a multisystem syndrome characterised by a reduction in physiological reserve and heightened susceptibility to poor health outcomes. The British Orthopaedic Association states that patients with a CFS of 5 or more should be managed using an established frailty pathway. [3] This includes a thorough geriatric assessment within 72 h of injury and multidisciplinary input into care. Previous work highlighted that frail patients have a 2.54 times higher chance of complications following surgery. [4] This study also stated that frailty positively correlates with hospital length of stay and patterns of discharge to assisted living facilities. The CFS is relied upon for its predictive success in the outcome of frail patients and to guide care decisions. A comprehensive literature review found the CFS to be predictive of outcomes in 74 % of cases of all frail, hospitalised patients; it had a strong association with mortality, complications, comorbidity, length of stay and cognition. [1] However, its utility in the context of orthogeriatric outcomes requires further clarification.

The objective of this review is to analyse the current literature focusing on the association between CFS and orthopaedic patient outcomes. This review will consider the benefits and disadvantages of the CFS as a predictor in orthopaedic surgery and will provide orthopaedic surgeons and perioperative clinicians insight into how they may use this tool to manage frail patients in their practice.