What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Older adults undergoing elective surgery (n=12281). Intervention: Frailty vs. Non-frail. Primary outcome: Postoperative complications (composite outcome of medical and surgical complications) (OR 2.16, 95% CI 1.29-3.62).

January 9, 2018BMC Medicine228 citationsOpen Access

Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis

JWJennifer Watt ATAndrea C. Tricco CTCatherine Talbot‐Hamon

Key Result

Frailty (OR 2.16) and cognitive impairment (OR 2.01) were significantly associated with developing postoperative complications in older adults undergoing elective surgery, whereas chronological age and ASA status were not.

Study Design

Type

Meta-Analysis (n=12,281)

Structured PICO

Are geriatric syndromes and other prognostic factors associated with postoperative complications in older adults undergoing elective surgery?

Population

12,281 older adults (≥60 years old) undergoing elective surgery across 44 prospective studies, evaluated for prognostic factors associated with adverse postoperative outcomes.

Exposure

Presence of prognostic factors (e.g., frailty, cognitive impairment, depressive symptoms, smoking)

Comparator

Absence of these prognostic factors

Outcome

Postoperative complications (composite outcome of medical and surgical complications)composite

Geriatric syndromes such as frailty and cognitive impairment, along with depressive symptoms and smoking, are significant modifiable prognostic factors for postoperative complications in older adults undergoing elective surgery.

Main Result

Odds Ratio: 2.16 (95% CI 1.29–3.62)

Limitations

Only studies published in English were included, which may limit generalizability.
Substantial heterogeneity existed between studies for some outcomes, which could not always be adequately explored.
The majority of included studies were cohort studies, meaning findings may be influenced by confounding.
Studies did not always report independent variables with non-significant associations, potentially leading to type 1 error.

Abstract

BACKGROUND: Elective surgeries can be associated with significant harm to older adults. The present study aimed to identify the prognostic factors associated with the development of postoperative complications among older adults undergoing elective surgery. METHODS: Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. Prospective studies reporting prognostic factors associated with postoperative complications (composite outcome of medical and surgical complications), functional decline, mortality, post-hospitalization discharge destination, and prolonged hospitalization among older adults undergoing elective surgery were included. Study characteristics and prognostic factors associated with the outcomes of interest were extracted independently by two reviewers. Random effects meta-analysis models were used to derive pooled effect estimates for prognostic factors and incidences of adverse outcomes. RESULTS: Of the 5692 titles and abstracts that were screened for inclusion, 44 studies (12,281 patients) reported on the following adverse postoperative outcomes: postoperative complications (n =28), postoperative mortality (n = 11), length of hospitalization (n = 21), functional decline (n = 6), and destination at discharge from hospital (n = 13). The pooled incidence of postoperative complications was 25.17% (95% confidence interval (CI) 18.03-33.98%, number needed to follow = 4). The geriatric syndromes of frailty (odds ratio (OR) 2.16, 95% CI 1.29-3.62) and cognitive impairment (OR 2.01, 95% CI 1.44-2.81) were associated with developing postoperative complications; however, there was no association with traditionally assessed prognostic factors such as age (OR 1.07, 95% CI 1.00-1.14) or American Society of Anesthesiologists status (OR 2.62, 95% CI 0.78-8.79). Besides frailty, other potentially modifiable prognostic factors, including depressive symptoms (OR 1.77, 95% CI 1.22-2.56) and smoking (OR 2.43, 95% CI 1.32-4.46), were also associated with developing postoperative complications. CONCLUSION: Geriatric syndromes are important prognostic factors for postoperative complications. We identified potentially modifiable prognostic factors (e.g., frailty, depressive symptoms, and smoking) associated with developing postoperative complications that can be targeted preoperatively to optimize care.

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