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Prognostic Value of Frailty in Aortic Surgery: A Systematic Review and Meta-Analysis Comparing Frailty Assessment
Mayara Leite Coutinho1, Lucas Monteiro Delgado2, Inez Ohashi Torres1
1Department of Vascular Surgery, Hospital das Clínicas FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Annals of Vascular Surgery
|June 29, 2026
Summary
Preoperative frailty significantly increases risks for mortality, complications, and non-home discharge after aortic surgery. Routine frailty assessment can improve patient risk stratification and surgical decision-making.
Area of Science:
- Vascular Surgery
- Geriatric Medicine
- Cardiovascular Research
Background:
- Frailty is a key factor influencing outcomes in aortic vascular surgery.
- Current methods for assessing frailty vary, and the optimal tool for risk stratification is unclear.
Purpose of the Study:
- To evaluate the prognostic value of preoperative frailty in aortic surgery.
- To compare the predictive performance of different frailty assessment instruments.
Main Methods:
- Systematic review and meta-analysis of PubMed, Embase, and Cochrane Library databases.
- Included 30 studies with 419,459 patients undergoing various aortic procedures.
- Focused on studies reporting preoperative frailty assessment and postoperative outcomes.
Main Results:
- Frailty is linked to increased early and late mortality (OR 2.20, HR 2.18).
- Frail patients face higher risks of major complications, acute kidney injury, and non-home discharge.
- Judgment-based tools showed higher effect estimates than deficit-accumulation indices; mFI-11 outperformed mFI-5.
Conclusions:
- Preoperative frailty is a strong predictor of adverse outcomes post-aortic surgery.
- Frailty assessment aids in risk stratification and perioperative decision-making for diverse aortic pathologies.
- Findings apply to open, endovascular, and hybrid aortic procedures across all segments.
