comparison of surgeon assessment to frailty measurement in abdominal aortic aneurysm repair background endovascular abdominal aortic aneurysm repair evar allows us to intervene on patients otherwise considered poor candidates for open repair despite its importance in determining operative approach no comparison has been made between the subjective eyeball test and an objective measurement of preoperative frailty for evar patientsmaterials and methods patients undergoing elective evar were identified in the vascular quality initiative vqi database 20032017 patients were classified unfit based on a surgeonreported variable frailty was defined using the vqiderived risk analysis index which includes sex age bmi renal failure congestive heart failure dyspnea preoperative ambulation and functional status the association between fitness andor frailty and adverse outcomes was determined by logistic regressionresults a total of 11694 patients undergoing elective evar were included of which only 181 were unfit whereas 346 were frail and overall 436 unfit or frail patients deemed unfit or frail had significantly increased odds of mortality complications and nonhome discharge p 0001 and both frailty and unfitness generated negative predictive values for these outcomes greater than 93 in adjusted logistic regression the addition of objective frailty significantly improved model performance in predicting nonhome discharge cstatistic 065 versus 071 p 0001 and complications 059 versus 061 p 001 but similarly predicted mortality 074 versus 073 p 099conclusions preoperative frailty assessment provides a useful objective measure of risk stratification as an adjunct to a physicians clinical intuition the addition of frailty expands the pool of highrisk patients who are more likely to experience adverse postoperative events after elective evar and may benefit from uniquely tailored perioperative interventions