Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematic review and meta-analysis

Abstract

Background: Frailty has been generally been associated with adverse events in older patients under surgery. Frailty phenotype is the most widely used instrument in the research literature. However the effect of the frailty phenotype on post-operative events was still unclear. The purpose of this systematic review was to explore the association between frailty phenotype and post-operative complications among surgical patients aged 60 years and over.

Methods: Relevant studies were identified by systematically searching of PubMed, Embase, the Cochrane Library and the Web of Science databases from their beginning to March 2017. Both random-effects models and fixed-effects models were used to combine the risk ratios (RRs) and 95% confidence intervals (CIs). A subgroup analysis was performed to identify the sources of heterogeneity and a sensitivity analysis to identify the strength of the results.

Results: Twelve prospective cohort studies involving a total of 2278 patients were included. The risk of post-operative complications in the frail group was higher than the non-frail group (RR: 1.6; 95% CI: 1.60-2.13). Compared with the robust group, geriatric patients with frailty or pre-frailty had a higher risk of post-operative complications. The RRs were 1.77 (95% CI: 1.40-2.25) and 1.45 (95% CI: 1.17-1.80), respectively.

Conclusion: Frailty phenotype should be considered as a useful risk assessment tool for preoperative evaluations of geriatric patients by medical staff.

Keywords: Frailty phenotype; Geriatric patients; Postoperative complications; Surgery.

Fig. 1

PRISMA 2009 Flow diagram of articles included in the present study

Fig. 2

Meta-analysis of the association between frailty status and post-operative complication

Fig. 3

Funnel plot