Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2319-2328
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2319
Impact of frailty on postoperative outcomes after hepatectomy: A systematic review and meta-analysis
Yao-Jia Lv, Guang-Xing Xu, Jia-Rong Lan
Yao-Jia Lv, Day Surgery Ward, Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Guang-Xing Xu, School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Jia-Rong Lan, Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou 313000, Zhejiang Province, China
Author contributions: Lv YJ, Xu GX, and Lan JR conceived and designed the study, collected the data, and performed the analysis; Lv YJ and Xu GX wrote the paper; Lan JR edited the paper; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia-Rong Lan, MD, Doctor, Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, No. 315 South Street, Huzhou 313000, Zhejiang Province, China. sdwaters@126.com
Received: February 24, 2024
Revised: April 28, 2024
Accepted: May 27, 2024
Published online: July 27, 2024
Processing time: 149 Days and 6.3 Hours
Abstract
BACKGROUND

The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.

AIM

To study the influence of frailty on postoperative outcomes, such as mortality, rate of complications, and length of hospitalization, following hepatectomy.

METHODS

PubMed, EMBASE, and Scopus databases were searched for observational studies with adult (≥ 18 years) patients after planned/elective hepatectomy. A random-effects model was used for all analyses, and the results are expressed as weighted mean difference (WMD), relative risk (RR), or hazards ratio (HR) with 95% confidence interval (CI).

RESULTS

Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality (RR = 2.76, 95%CI: 2.10-3.64), mortality at 30 d (RR = 4.60, 95%CI: 1.85-11.40), and mortality at 90 d (RR = 2.52, 95%CI: 1.70-3.75) in the postoperative period. Frail patients had a poorer long-term survival (HR = 2.89, 95%CI: 1.84-4.53) and higher incidence of “any” complications (RR = 1.69, 95%CI: 1.40-2.03) and major (grade III or higher on the Clavien-Dindo scale) complications (RR = 2.69, 95%CI: 1.85-3.92). Frailty was correlated with markedly lengthier hospital stay (WMD = 3.65, 95%CI: 1.45-5.85).

CONCLUSION

Frailty correlates with elevated risks of mortality, complications, and prolonged hospitalization, which need to be considered in surgical management. Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.

Keywords: Frailty; Frail adults; Hepatic resection; Hepatectomy; Complications; Mortality; Survival; Clinical outcomes; Meta-analysis

Core Tip: This meta-analysis examined how frailty affects people undergoing liver surgery (hepatectomy). Findings from published studies were utilized to compare frail individuals to non-frail ones in terms of outcomes after hepatectomy. The findings show that frail individuals had higher mortality rates while in the hospital and within 30 d and 90 d after surgery, compared to non-frail individuals. Frail people also had lower long-term survival rates, experienced more complications, and had to stay in the hospital longer. These findings suggest that it is important to consider frailty when planning hepatectomy.