Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Abstract

BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

The impact of age and ageing on hepatocarcinoma surgery: Short‐ and long‐term outcomes in a multicentre propensity‐matched cohort

“…We observed that the incidence of post‐operative morbidity raised from 31% to 49.5% and 90‐day mortality from 1.4% to 7.5% in the youngest group compared to the oldest group respectively. Whilst not statistically significant, these figures require consideration and may be indicators of the failure‐to‐rescue syndrome defined as the probability of death after a surgical complication . In fact, at the multivariate analysis, we observed that age over 75 years was the only independent factor for having complications after liver resection with 2.5‐fold increased risk.…”

“…In fact, at the multivariate analysis, we observed that age over 75 years was the only independent factor for having complications after liver resection with 2.5‐fold increased risk. This risk is likely to be the expression of the age‐related frailty, a state of vulnerability to poor resolution of homeostasis following a stressor event. It develops as a consequence of cumulative decline across multiple physiological systems, and it has been usually associated with cells ageing.…”

“…Strong patient motivation for surgery and a lack of standardized risk assessment may expose patients to excessive risk of major post‐operative morbidity and mortality or poor long‐term prognosis. Conversely, failure to offer surgery with curative intent to patients who are judged unfit based on generic and imprecise risk variables is unacceptable …”

The Impact of Frailty on Long‐Term Patient‐Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study

“…This study revealed remarkably high 30‐day, 180‐day, and 1‐year mortality in Medicare patients with frailty who underwent an EGS. Similar to findings from other studies, patients with frailty had at least 2 times the risk of 1‐year mortality compared with non‐frail patients . Additionally, this relationship was dose dependent, where a higher degree of frailty conferred a greater risk of mortality.…”

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

“…5,[10][11][12][13] In contrast, the frailty index is a multidimensional score, which may qualify for being considered as a complementary predictor of adverse outcomes, since it relies on a different definition than previous parameters. [14][15][16][17] However, to date no studies tested its association with short-term postoperative outcomes after RNU. Based on this unmet need, we investigated rates and trends over time of frail patients undergoing RNU, using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator.…”