The Effect of Frailty on Prognosis of Patients Undergoing Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.

BACKGROUND

This study aimed to systematically review the impact of frailty on outcomes following abdominal aortic aneurysm (AAA) surgery.

METHODS

MEDLINE, Embase, and Scopus were searched for studies of frailty on AAA surgery. A modified Newcastle-Ottawa scale was used to assess the quality of the included studies. The impact of frailty on outcomes was expressed as odds ratios (ORs) or hazard ratios (HRs) using a random effects model.

RESULTS

A total of 12 studies were finally included for analysis. Overall frailty was associated with a significantly increased risk of 30-day mortality in patients who underwent AAA surgery (OR 4.380, 95% confidence interval [CI] 3.590-5.340, I2 = 0%). Functionally dependent patients exhibited a substantial rise in 30-day mortality risk following AAA surgery compared to independent patients (OR 4.690, 95% CI 3.730-5.910 I2 = 0%). Frailty was also associated with a higher risk of long-term all-cause mortality in the included population (HR 2.200, 95% CI 1.750-2.780, I2 = 0%). Central muscle mass was significantly associated with a higher risk of worse long-term survival in patients who underwent AAA surgery (HR 2.130, 95% CI 1.670-2.720, I2 = 0%). Functional dependency was associated with a significantly increased risk of complications in patients undergoing major AAA surgery (OR 2.570, 95% CI 2.020-3.270, I2 = 54%).

CONCLUSION

Frailty correlates with both short-term and long-term mortality and survival in AAA patients. Therefore, it is imperative to conduct thorough assessments of functional status or muscle volume preoperatively, followed by appropriate patient stratification to optimize patient outcomes.