In older adults undergoing surgical fixation or arthroplasty following upper limb fractures, does frailty predict post-operative complications and mortality? A systematic review and meta-analysis.

BACKGROUND: There is growing recognition of the role of clinical frailty and its impact on health outcomes in aging cohorts. Frailty may be associated with mortality and complications following fracture; however, its impact on upper limb outcomes has yet to be quantified. This systematic review aims to evaluate the association between pre-operative frailty and post-operative mortality and complications in adults undergoing surgical treatment for upper limb fractures. Secondary outcomes included reoperation, adverse discharge destination and length of stay.

METHODS: MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched on January 31, 2025, to identify studies that assessed pre-operative patient frailty and post-operative outcomes in adults following traumatic upper limb fractures. Data on 30-day mortality, post-operative complications, reoperation, hospital readmission, adverse discharge, Clavien-Dindo IV complications, and length of stay were extracted. Data were pooled using random-effects and fixed effects models for meta-analyses. Grading of Recommendations Assessment, Development and Evaluation assessment was used to assess the quality of available evidence.

RESULTS: Of the 4,013 records identified, 9 retrospective cohort studies were eligible for inclusion. Frailty was significantly associated with increased risk of 30-day mortality (odds ratio [OR] = 3.40, 95% confidence interval [CI] = 2.90-3.99, P < .001), post-operative complications (OR = 2.78, 95% CI = 1.99-3.88, P < .001), adverse discharge (OR = 2.96, 95% CI = 1.75-5.02, P < .001), and hospital readmission (OR = 3.73, 95% CI = 1.86-7.46, P < .001). No statistically significant association between frailty and reoperation was found (OR = 1.61, 95% CI = 1.36-1.91, P < .001). Grading of Recommendations Assessment, Development and Evaluation assessment found moderate certainty for post-operative complications and reoperation, and low to very low certainty for 30-day mortality, readmission, adverse discharge, Clavien-Dindo IV complications, and length of stay.

CONCLUSION: Pre-operative frailty is associated with increased early mortality, post-operative complications, adverse discharge, and hospital readmission following surgical treatment for upper limb fractures in adults. Future prospective investigations are needed to standardize frailty screening and inform surgical decision-making in upper limb fractures.