# Impact of frailty on outcomes of pancreatic surgery: a systematic review and meta-analysis

## TL;DR

Frail patients undergoing pancreatic surgery face higher short-term mortality and some complications, but not major ones.

## Contribution

This study systematically reviews and quantifies the impact of frailty on outcomes after pancreatic surgery.

## Key findings

- Frailty increases the risk of all complications after pancreatic surgery.
- Frailty is associated with higher short-term mortality after pancreatic surgery.
- No significant difference in major complications, readmissions, or reoperations between frail and non-frail patients.

## Abstract

Frailty is being recognized as a risk factor for adverse outcomes after various surgical procedures. However, its impact on pancreatic surgery outcomes remains uncertain. We hereby reviewed evidence on the difference in the risk of complications and mortality between frail and non-frail patients undergoing pancreatic surgery.

PubMed, Embase, Scopus, and Web of Science were searched from 1st January 1980 to 17th June 2025, for relevant studies. The endpoints of the study were all complications, Clavien-Dindo grade ≥3 (CD ≥ 3) complications, reoperation, and readmissions. Random-effect meta-analysis was conducted.

A total of 11 studies were included. A pooled analysis revealed that frailty was associated with an increased risk of all complications in patients undergoing pancreatic surgery (OR: 1.51, 95% CI: 1.01–2.24, I2 = 61%). Meta-analysis showed no significant difference between frail and non-frail patients for CD ≥ 3 complications (OR: 1.34, 95% CI: 0.86, 2.09 I2 = 31%), readmission (OR: 1.41, 95% CI: 0.75, 2.62 I2 = 0%) and reoperation (OR: 2.32, 95% CI: 0.63, 8.50 I2 = 0%). However, frail patients had a significantly higher risk of short-term (OR: 2.54, 95% CI: 1.39, 4.61, I2 = 50%) mortality as compared to non-frail patients after pancreatic surgery. Sensitivity and subgroup analysis generated mixed results.

The presence of preoperative frailty may lead to increased risk of short-term mortality and morbidity in patients undergoing pancreatic surgery. Frailty was not associated with major complications, readmission, or reoperations. However, results must be interpreted with caution owing to limited data and high inter-study heterogeneity.

https://www.crd.york.ac.uk/prospero/, CRD420251049842.