The aging population in the United States continues to grow and is expected to increase by 35% in the upcoming decades [1,2]. Over the years, there has been a steady increase in the number of elderly patients requiring operative intervention [3]. Elderly patients routinely present with multiple chronic conditions with polypharmacy along with physiological and functional impairments [4]. However; old age does not always equal adverse outcomes. Variability exists among elderly patients based on individual physiologic reserve which can be assessed by frailty.

Frailty has been an established tool for predicting post-operative outcomes across surgical specialties [4], [5], [6]. In patients undergoing vascular intervention, frail patients have been shown to have higher morbidity, mortality, and even failure to rescue in comparison to non-frail patients [6], [7], [8], [9]. Frailty syndrome is the amalgamation of intrinsic patient factors (such as age, gender, nutritional status, functional capacity, hormonal balance, and preexisting medical conditions) which result in increased morbidity and mortality after surgical intervention [1]. Social, economic, racial, and ethnic factors impact frailty; however, these disparities are not well understood.

Health disparities are well documented in the surgical literature highlighting the differences in the quality of health care across racial, ethnic, gender, and demographic groups (biology or environment) [10,11]. Patients with peripheral artery disease (PAD) progress to develop disabling symptoms of ischemia and functional loss. Chronic limb-threatening ischemia (CLTI) represents the end stage of lower extremity disease which if not treated adequately leads to limb loss and increased morbidity and mortality. There have been multiple studies describing racial, ethnic, and gender disparities in PAD [8,11,12]. However; there is a paucity of data in surgical literature regarding the role of frailty and disparities among patients undergoing surgical intervention. We aimed to assess whether race influences frailty status in geriatric patients undergoing revascularization for PAD with CLTI.