Prevalence of physical frailty and its associated factors among elderly patients undergoing hepatobiliary pancreatic surgery in China

Abstract

Frailty is a geriatric syndrome characterized by a multisystem physiological decline, increased vulnerability to stressors, and adverse clinical outcomes. However, there is a knowledge gap regarding the association between frailty and its influencing factors. This study aimed to understand the current status of preoperative frailty in elderly patients with hepatobiliary pancreatic disease (HBP) and analyze debilitation-related factors. We enrolled 220 participants aged ≥ 65 years who underwent HBP surgery at two hospitals in China between December 2023 and February 2024. The physical frailty of elderly participants in communities with different characteristics was compared using Kruskal-Wallis and chi-square tests. Ordinal logistic regression analysis was used to analyze the factors influencing preoperative frailty. A total of 212 patients were included in the analysis based on the inclusion and exclusion criteria, with an overall prevalence of frailty at 53 (25%). Ordinal logistic regression analysis results showed that current smoking (odds ratio [OR] = 2.584, p = 0.006) was an independent risk factor for preoperative frailty in elderly participants with HBP. In contrast, exercise habits (OR = 0.323, p < 0.001), two or more multimorbidity statuses (OR = 0.495, p = 0.033), and independent status (OR = 0.216, p < 0.001) were protective factors. Our results suggest that having good exercise habits, not smoking, and independent status can prevent frailty progression in older adults who require HBP surgery. Interventions for frail elderly patients should be supported preoperatively by strengthening exercises to improve tolerance to surgery.

Keywords: aging; frailty; frailty assessment; hepatobiliary pancreatic surgery; influencing factor.

Figure 1.

Study flowchart.

Figure 2.

Overview of population of each factor of frailty in pre-frailty and frailty in elderly hepatobiliary and pancreatic patients (by the Fried's Frailty Phenotype).