Influence of Frailty on Outcome in Older Patients Undergoing Non-Cardiac Surgery - A Systematic Review and Meta-Analysis

Tjeertes Elke K.M, van Fessem Joris M.K, Mattace-Raso Francesco U.S, Hoofwijk Anton G.M, Stolker Robert Jan, Hoeks Sanne E

Table 1 Study demographics and method of determining frailty.

Author N Setting Period Design Type of surgery Frailty score Definition of complication Quality Abt 1193 Multicenter cohort study (NSQIP) 2006-2013 Prospective Head and neck cancer surgery Modified frailty index CD 4 Good Adams 6727 Multicenter cohort study (NSQIP) 2005-2010 Prospective Head and neck cancer surgery Modified frailty index CD 4 or 5 Good Arya 23027 Multicenter cohort study (NSQIP) 2005-2012 Prospective Vascular surgery (Open or EVAR) Modified frailty index CD 4 Good Augustin 13020 Multicenter cohort study (NSQIP) 2005-2010 Prospective Pancreatic resections Modified frailty index CD 4 Good Brahmbhatt 24645 Multicenter cohort study (NSQIP) 2005-2012 Prospective Infrainguinal vascular surgery Modified frailty index CD 4 Good Bras 90 Single-center cohort study 2008-2013 Retrospective Surgery for head and neck cancer Groningen frailty indicator CD ≥ 2 Fair Chappidi 2679 Multicenter cohort study (NSQIP) 2011-2013 Prospective Radical cystectomy Modified frailty index CD 4 or 5 Good Chimukangara 885 Multicenter cohort study (NSQIP) 2011-2013 Prospective Paraesofageal hernia repair Modified frailty index CD ≥ 3 Fair Cloney 243 Multicenter cohort study (NSQIP) 2000-2012 Prospective Glioblastoma surgery Modified frailty index Complications (Glioma Outcomes Project System) Fair Cooper 415 Multicenter cohort study 2010-2013 Prospective General and orthopedic surgery Frailty phenotype; frailty index Major complications Fair Courtney-Brooks 37 Single-center cohort study 2011 Prospective Surgery for gynecologic cancer Fried frailty criteria Surgical complications (NSQIP) Fair Dale 76 Single-center cohort study 2007-2011 Prospective Pancreaticoduodenectomy 4 (of 5) components of Fried frailty criteria; VES-13 CD ≥ 3 Fair Dasgupta 125 Single-center cohort study 2002-2003 Prospective Elective noncardiac surgery (82%) orthopedic) Edmonton frail scale Cardiac - / pulmonary comlications, POD Fair Farhat 35334 Multicenter cohort study (NSQIP) 2005-2009 Prospective Emergency general surgery Modified frailty index Any complication (not mortality) Fair Flexman 52671 Multicenter cohort study (NSQIP) 2006-2012 Prospective Spine surgery Modified frailty index Major complications Good Hewitt 102 Multicenter cohort study 2013 Prospective Emergency general surgery Rockwood clinical frailty scale Not reported Fair Huisman 328 Multicenter cohort study 2008-2012 Prospective Surgery for solid tumors Groningen frailty indicator; VES-13 CD ≥ 3 Good Joseph 220 Single-center cohort study 2012-2014 Prospective Emergency general surgery Rockwood clinical frailty scale Surgical complications (NSQIP) Fair Kenig 184 Single-center cohort study 2013-2014 Prospective Emergency abdominal surgery VES-13, GFI; Rockwood; Balducci; TRST; Geriatric-8 Any complication (CD) Fair Kim 197 Single-center cohort study 2012-2014 Prospective Elective noncardiac surgery Fried frailty criteria Surgical complications (NSQIP) Good Kim 275 Single-center cohort study 2011-2012 Prospective Elective intermediate-risk or high-risk surgery Multidimensional frailty score Surgical complications (NSQIP) Good Krishnan 178 Single-center cohort study 2011 Prospective Low trauma hip fracture surgery Frailty index Not reported Poor Kristjansson 178 Multicenter cohort study 2008-2011 Prospective Elective surgery for colorectal cancer Comprehensive geriatric assessment CD ≥ 2 Good Kua 82 Single-center cohort study 2013 Prospective Hip fracture surgery Edmonton frail scale; (modified) Fried frailty criteria Any complication Fair Lascano 41681 Multicenter cohort study (NSQIP) 2005-2013 Prospective Surgery for urologic cancer Modified frailty index CD 4 Good Lasithiotakis 57 Single-center cohort study 2008-2011 Prospective Elective laparoscopic cholecystectomy Comprehensive geriatric assessment Any complication Poor Leung 63 Single-center cohort study 2007 Prospective Noncardiac surgery Fried frailty criteria Not reported Fair Levy 23104 Multicenter cohort study (NSQIP) 2008 to 2014 Prospective Robot-assisted radical prostatectomy Modified frailty index CD 4 Good Li 189 Single-center cohort study Not reported Prospective Major intra-abdominal surgery Fried frailty criteria CD Fair Louwers 10300 Multicenter cohort study (NSQIP) 2005-2011 Prospective Hepatectomy Modified frailty index CD 4 Good Makary 594 Single-center cohort study 2005-2006 Prospective Elective surgery Fried frailty criteria Surgical complications (NSQIP) Good McAdams-DeMarco 537 Single-center cohort study 2008-2013 Prospective Kidney transplant surgery Fried frailty criteria Not reported Fair McIsaac 202811 Single-center cohort study 2002-2012 Retrospective Major elective noncardiac surgery ACG frailty-defining diagnoses indicator Not reported Good McIsaac 125163 Single-center cohort study 2003-2012 Retrospective Total joint arthroplasty ACG frailty-defining diagnoses indicator ICU-admission Good Melin 44832 Multicenter cohort study (NSQIP) 2005-2011 Prospective Carotid endarterectomy Frailty-based bedside Risk Analysis Index Not reported Fair Mogal 9986 Multicenter cohort study (NSQIP) 2005-2012 Prospective Pancreaticoduodenectomy Modified frailty index CD 3 or 4 Good Mosquera 232352 Multicenter cohort study (NSQIP) 2005-2012 Prospective elective high-risk surgery Modified frailty index Major and minor complications Fair Neuman 12979 Single-center cohort study 1992-2005 Retrospective Elective colorectal cancer surgery ACG frailty-defining diagnoses indicator Readmission within 30 days Fair Obeid 58448 Multicenter cohort study (NSQIP) 2005-2009 Prospective Laparoscopic and open colectomy Modified frailty index CD 4 or 5 Fair Partridge 125 Single-center cohort study 2011 Prospective Arterial vascular surgery Edmonton frail scale Composite postoperative complications Fair Pearl 4330 Multicenter cohort study (NSQIP) 2011-2014 Prospective Radical cystectomy Modified frailty index Major in-hospital complications Good Phan 3920 Multicenter cohort study (NSQIP) 2010-2014 Prospective Elective anterior lumbar interbody fusion (ALIF) surgery Modified frailty index Any complication Good Reisinger 159 Single-center cohort study 2010-2012 Prospective Colorectal surgery Groningen frailty indicator Sepsis Good Revenig 351 Single-center cohort study Not reported Prospective Major intra-abdominal surgery Fried frailty criteria CD 1-4 Fair Revenig 80 Single-center cohort study Not reported Prospective Intra-abdominal minimally invasive surgery Fried frailty criteria CD 1-4 Fair Revenig 189 Single-center cohort study Not reported Prospective Major intra-abdominal surgery Fried frailty criteria Any complication Good Robinson 72 Single-center cohort study 2007-2010 Prospective Colorectal surgery Rockwood clinical frailty scale Any postoperative complication (VASQIP) Fair Shin 6148 ACDF; 817 PCF Multicenter cohort study (NSQIP) 2005-2012 Prospective Cervical spine fusion; anterior cervical discectomy and fusion or posterior cervical fusion Modified frailty index CD 4 Good Shin 14583 THA; 25223 TKA Multicenter cohort study (NSQIP) 2005-2012 Prospective Total hip and knee arthroplasty Modified frailty index CD 4 Good Suskind 95108 Multicenter cohort study (NSQIP) 2007-2013 Prospective Common urological surgery Modified frailty index Major and minor complications Good Suskind 20794 Multicenter cohort study (NSQIP) 2011-2013 Prospective Inpatient urological surgery Modified frailty index Not reported Good Tan 83 Multicenter cohort study 2008-2010 Prospective Colorectal surgery Fried frailty criteria CD ≥ 2 Fair Tegels 127 Single-center cohort study 2005-2012 Retrospective Surgery for gastric cancer Groningen frailty indicator CD ≥ 3 Fair Tsiouris 1940 Multicenter cohort study (NSQIP) 2005-2010 Prospective Open lobectomy Modified frailty index CD 4 Good Ugolini 46 Single-center cohort study 2009-2012 Prospective Elective colorectal cancer surgery Groningen frailty indicator; VES-13 Not reported Poor Uppal 6551 Multicenter cohort study (NSQIP) 2008-2011 Prospective Surgery for gynecologic cancer Modified frailty index CD 4 and 5 Good