For a study, the researchers examined the intersections of chronological age and physiological age via frailty to determine the influence of surgical invasiveness on patient results. There were 598 patients with ASD that were taken under consideration (55.3 years, 59.7% F, 28.3 kg/m2), 29.8% of patients were older than 70. At BL, 51.3% of patients were NF, 37.5% F, and 11.2% SF. 66 (11%) patients were NF and elderly. About 24.2% of NF-elderly patients improved in SRS-Schwab by 1 year and had no reoperation or complication postoperatively. Binary regression testing found a relation between worsening SRS-Schwab, post-op complication, and reoperation with invasiveness score (odds ratio: 1.056[1.01–1.102], P=0.011). The risk/benefit cut-off was 10 (P=0.004). Patients below-provided threshold was 7.9 (2.2–28.4) times more likely to have a Good Outcome. 156 patients were elderly and F/SF, with 16.7% having a good result, with a risk/benefit cut-off point of less than 8(4.4[2.2–9.0], P<0.001). Frailty status affected the balance of surgical invasiveness relative to operative risk in an inverse manner. In contrast, the opposite was determined amongst elderly patients with a frailty status less than their chronological age. Surgeons were advised to consider incorporating frailty status over age status when determining realignment plans in patients of advanced age.