Against the backdrop of the accelerating trend of social aging, the proportion of surgical procedures among the elderly population continues to rise. Despite the continuous advances in surgery, anesthesia technology, and perioperative medicine, the elderly patients undergoing surgical treatment still suffer from poor postoperative outcomes. Frailty indicates the decline in the physiological reserves of multiple systems in elderly people, which can cause rapid and drastic changes in physiological functions due to mild external harmful stimuli. It is an important risk factor for postoperative adverse events. In this article, we review relevant literature on the relationship between frailty and perioperative adverse events in recent years, and provide a review on the concept of frailty, evaluation tools for frailty, impact of frailty on perioperative outcomes, and perioperative optimization strategies for frail patients, so as to provide theoretical support for optimizing the physical functions of frail elderly patients in clinical practice and avoiding perioperative adverse outcomes.