Frailty as a Predictor of Outcomes in Oncological Liver Resections

Introduction Frailty has emerged as a significant predictor of surgical outcomes, particularly in the elderly undergoing complex procedures like oncological liver resections. This systematic review and meta-analysis aim to consolidate the evidence on the impact of frailty on morbidity and mortality in this patient population.

Methods This study involved a systematic review and meta-analysis of 10 studies, including 71,102 patients, comparing outcomes between frail and non-frail individuals undergoing liver resections. Frailty was assessed using various validated scores.

Results

• Patient Characteristics: Frail patients were generally older and had lower preoperative albumin levels, indicating poorer nutritional status.
• Morbidity and Mortality: Frail patients had significantly higher rates of overall morbidity (OR 2.9), major complications (OR 2.2), surgical complications (OR 1.4), and postoperative liver failure (OR 1.3). Mortality rates were three times higher in frail patients.
• Readmissions and Length of Stay: Frail patients had a higher readmission rate and a longer hospital stay, though the latter showed significant interstudy heterogeneity.

Discussion The findings underscore the importance of preoperative frailty assessment in patients undergoing liver resection. Frailty, characterized by reduced physiological reserve, significantly predicts adverse outcomes. Integrating frailty scores into preoperative evaluations can aid in patient selection, improve surgical planning, and enhance postoperative care.

Conclusion Frailty is a robust predictor of morbidity and mortality in patients undergoing oncological liver resections. Incorporating frailty assessment into clinical practice can help optimize surgical outcomes and patient management.