James LA, et al. - In this single-center retrospective study, researchers investigated if frail patients exhibit less hemodynamic variability under anesthesia and if the link between frailty and 30-day mortality is mediated by variability. This study included 1223 patients (≥65 years of age) undergoing surgery between July 2008 and December 2012, and age >70, preoperative body mass index <18.5, hematocrit <35%, albumin <3.4 g/dL, and creatinine >2.0 mg/dL were used as markers of frailty. Findings revealed an association of frailty with less intraoperative blood pressure variation. The episodes of absolute change >15% in fractional mean arterial pressure partially mediated the link between frailty and 30-day mortality. Based on this, autonomic dysregulation was suggested to possibly be a modest part of the mechanism behind the link between frailty and perioperative mortality. The result is consistent with recent literature, indicating that lower perioperative mortality is conferred by an intact autonomic nervous system.