Editor

We thank Hu et al. for their interest in our paper1. We regret that they do not seem to be familiar with the ACS-NSQIP dataset. As research transcends traditional bounds and becomes global, it is encouraged that authors and reviewers take the time to educate themselves and understand data sources they are not familiar with. This basic knowledge would have answered the majority of the group's queries. In this work, we included a description of the data source, a link to the data dictionary, and a thorough discussion of the limitations that could have assisted. Hu et al. are incorrect in their assumption that the modified frailty index is a nutritional assessment. Both the tool and the analysis used have been well described and validated2-5. They are also incorrect in stating that BMI was used as a nutritional indicator. This analysis centered on emergent cases, and the indication for operation is detailed in Table 2. The opinions and enthusiasm of Hu et al. for how frailty should be evaluated is appreciated. However, the scope of the problem needs to be defined before embarking on sub-group analysis and action plans to address a problem. This work was the first national assessment of the prevalence of frailty and its influence on postoperative outcomes in older adults undergoing high-risk emergency colorectal resections in the USA, providing the necessary foundation. With this base, further investigation including detailed demographic and socioeconomic details can be undertaken.