Preoperative frailty in patients undergoing emergency surgery is associated with increases in the risk of postoperative complications and various long‑term adverse outcomes. Elderly patients undergoing emergency surgery are severely ill with rapid disease progression. Fast and easy frailty assessment should be carried out before surgery and appropriate interventions made in time to effectively improve clinical prognosis. This article provides a systematic review of the definition of preoperative frailty, the assessment and optimization of preoperative frailty, and intraoperative and postoperative management in elderly emergency surgery patients, in an effort to enhance clinical anaesthesiologists' assessment and management of preoperative frailty in elderly emergency surgery patients, and achieve optimal improvement of patients' clinical outcomes.