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.
Meta-Analysis (n=12,281)
Are geriatric syndromes and other prognostic factors associated with postoperative complications in older adults undergoing elective surgery?
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.
Odds Ratio: 2.16 (95% CI 1.29–3.62)
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.
Watt et al. (2018) conducted a meta-analysis in Older adults undergoing elective surgery (n=12,281). Frailty vs. Non-frail was evaluated on Postoperative complications (composite outcome of medical and surgical complications) (OR 2.16, 95% CI 1.29-3.62). 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.