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Background <p>Frailty prevalence is high in elderly, especially those experiencing surgical operation. Identifying high-risk individuals who planned to receive surgery becomes imperative.</p> Objective <p>Current evidence from observational studies suggesting the specific impact of frailty on cardiac surgery remains ambiguous, the systematic review and meta-analysis aimed to consolidate existing data to evaluate the impact of frailty on outcomes in elderly patients undergoing cardiac surgery.</p> Methods <p>Searches were conducted in PubMed, Web of Science, Cochrane, and Wanfang database from inception to May 31, 2025, and the review was subsequently updated to February 17, 2026. The primary outcomes were all-cause mortality after cardiac surgery, atrial fibrillation (AF), delirium, and stroke. Secondary outcomes included other related complications including acute kidney injury (AKI), infection, pulmonary complications, bleeding, rehospitalization, nonhome discharge, length of intensive care unit (ICU) stay, length of hospital stay (LOS). </p> Results <p>Twenty-five studies were incorporated into the meta-analyses, involving 20 original studies and five database studies. The results showed that mortality among frail elderly patients undergoing cardiac surgeries was higher than non-frail counterparts both in original studies [risk ratio (RR) 3.63; 95% confidence interval (CI), 2.78-4.72; I<sup>2</sup>= 19%; P &lt; 0.001] and database studies (RR 3.84; 95% CI, 3.63-4.06; I = 74%; P &lt; 0.001). The risks of AF, delirium, stroke were higher in frail elderly patients: AF (OR 1.30; 95% CI: 1.03 - 1.65; I2 = 0%; P = 0.03), delirium (OR 2.08; 95% CI: 1.53 - 2.81; I2 = 40%; P &lt; 0.001), stroke (OR 2.81; 95% CI: 2.08 - 3.81; I2 = 0%; P &lt; 0.001). Frailty was significantly associated with increased risks of other postoperative complications in older patients after cardiac surgeries. Subgroup analyses indicated that database studies performed comparably to original studies in predicting postoperative complications, yet demonstrated significant heterogeneity in reporting outcomes.</p> Conclusions <p>Our study underscores the pivotal impact of frailty on mortality, AF, delirium, stroke and other complications in the elderly patients undergoing cardiac surgeries. The results advocate for the incorporation of frailty assessments into the preoperative evaluation process. </p> Registration information <p>Registered in the International Prospective Register of Systematic Reviews (CRD420251115942).</p>

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Frailty and postoperative complications in elderly patients undergoing cardiac surgery: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月24日

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  • Xinfang Zhang,
  • Yuan Li,
  • Lu Zhang,
  • Ying Xiao,
  • Huigen Huang,
  • Feifei Feng,
  • Jimei Chen,
  • Sheng Wang,
  • Xiaoxia Chen,
  • Ling Wang

摘要

Background

Frailty prevalence is high in elderly, especially those experiencing surgical operation. Identifying high-risk individuals who planned to receive surgery becomes imperative.

Objective

Current evidence from observational studies suggesting the specific impact of frailty on cardiac surgery remains ambiguous, the systematic review and meta-analysis aimed to consolidate existing data to evaluate the impact of frailty on outcomes in elderly patients undergoing cardiac surgery.

Methods

Searches were conducted in PubMed, Web of Science, Cochrane, and Wanfang database from inception to May 31, 2025, and the review was subsequently updated to February 17, 2026. The primary outcomes were all-cause mortality after cardiac surgery, atrial fibrillation (AF), delirium, and stroke. Secondary outcomes included other related complications including acute kidney injury (AKI), infection, pulmonary complications, bleeding, rehospitalization, nonhome discharge, length of intensive care unit (ICU) stay, length of hospital stay (LOS).

Results

Twenty-five studies were incorporated into the meta-analyses, involving 20 original studies and five database studies. The results showed that mortality among frail elderly patients undergoing cardiac surgeries was higher than non-frail counterparts both in original studies [risk ratio (RR) 3.63; 95% confidence interval (CI), 2.78-4.72; I2= 19%; P < 0.001] and database studies (RR 3.84; 95% CI, 3.63-4.06; I = 74%; P < 0.001). The risks of AF, delirium, stroke were higher in frail elderly patients: AF (OR 1.30; 95% CI: 1.03 - 1.65; I2 = 0%; P = 0.03), delirium (OR 2.08; 95% CI: 1.53 - 2.81; I2 = 40%; P < 0.001), stroke (OR 2.81; 95% CI: 2.08 - 3.81; I2 = 0%; P < 0.001). Frailty was significantly associated with increased risks of other postoperative complications in older patients after cardiac surgeries. Subgroup analyses indicated that database studies performed comparably to original studies in predicting postoperative complications, yet demonstrated significant heterogeneity in reporting outcomes.

Conclusions

Our study underscores the pivotal impact of frailty on mortality, AF, delirium, stroke and other complications in the elderly patients undergoing cardiac surgeries. The results advocate for the incorporation of frailty assessments into the preoperative evaluation process.

Registration information

Registered in the International Prospective Register of Systematic Reviews (CRD420251115942).