title: Systematic review and meta-analysis of the association between frailty and outcome in surgical patients.
abstract: BACKGROUND
  Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear.
  
  
  METHODS
  A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement.
  
  
  RESULTS
  Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62-4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49-2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02-2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41-9.55).
  
  
  CONCLUSIONS
  The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients.
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust , UK.
authors.forename: K
authors.initials: K
authors.lastname: Oakland
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Nadler
authors.affiliation: University of Cambridge , UK.
authors.forename: L
authors.initials: L
authors.lastname: Cresswell
authors.affiliation: University of Cambridge , UK.
authors.forename: D
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust , UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Coughlin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D055948:Sarcopenia; D013514:Surgical Procedures, Operative / Q000401:mortality*
keywords: Elderly; Frailty; Mortality rates; Postoperative outcomes; Sarcopenia