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Background There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the geriatric perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. Objective To compare the application effects of FRAIL scale, Clinical Frailty Scale (CFS), perioperative frailty index and 5-item modified frailty index (mFI-5) in preoperative frailty assessment in elderly surgical patients, in order to provide a reference for healthcare professionals to choose appropriate frailty assessment tools. Methods By convenient sampling method, a total of 329 hospitalized elderly patients admitted to Guangdong Hospital of Traditional Chinese Medicine for elective surgery from February to May 2023 were selected. The mFI-11, FRAIL scale, CFS, mFI-5 and perioperative frailty index were used for frailty assessment. The Kappa test was used to evaluate the consistency between the five frailty assessment tools. Using the mFI-11 evaluation results as a reference, the diagnostic value of the other four tools on the incidence of preoperative frailty in elderly patients was analyzed by decision curve analysis (DCA) and receiver operating characteristic (ROC) curve, and the area under ROC curve (AUC) was calculated. The optimal cut-off values of the four frailty assessment tools were determined according to the Yoden index. The performance indicators of the four frailty assessment tools at the original and optimal cut-off values were calculated. Results CFS and perioperative frailty index showed the highest consistency in the assessment of preoperative frailty in the elderly (Kappa=0.655, P