DOI: 10.1093/bjs/znad258.076 ISSN:

641 Impact of Frailty on Patient Outcomes After Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

M Elhadi, H Faraj, A Khaled, A Khaled, A BenGhatnsh, A Msherghi
  • Surgery



To determine the impact of frailty on patient outcomes after undergoing cardiac surgery.


An analysis of frail versus non-frail patients who had undergone cardiac surgery was conducted using data from Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature, all searched in April 2022. The primary outcomes of early postoperative mortality and major adverse cardiovascular events (MACE) were examined, as well as secondary outcomes, including long-term mortality and complications. Data were analyzed using R version 4.0.3.


A total of 22 studies, including 102,323 frail and 2,187,814 non-frail patients, were included in the analysis. Frailty was found to be significantly associated with higher early mortality (RR: 2.93; 95% CI, 2.19–3.93; P < 0.01; I2 = 17.2%) and MACE (RR: 2.07; 95% CI, 1.21–3.55; P = 0.03; I2 = 22.9%) compared to non-frail patients. Frailty was also associated with a higher risk of acute kidney injury and renal impairment (RR: 3.67; 95% CI, 2.85–4.73; P = 0.03; I2 = 3.9%). In the long term, a higher mortality rate was observed in frail patients (RR: 2.93; 95% CI, 1.69–5.07; P = 0.02; I2 = 22.4%). However, no significant differences were found in pneumonia, respiratory complications, sepsis, or reoperation rates between frail and non-frail patients.


Frailty is associated with higher mortality and MACE in patients undergoing cardiac surgery and a higher risk of acute kidney injury. Frailty should be considered an important factor in preoperative risk assessment and perioperative care for these patients.

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