The Association of an Electronic Frailty Index with Glaucoma Shunt Outcomes

Background/Objectives: Recent studies have shown frailty to be a significant predictor of postoperative complications and mortality across multiple surgical fields. Older adults with glaucoma refractory to medical management often require drainage implantation to achieve intraocular pressure control, yet the impact of frailty remains unstudied. This study evaluated the association of frailty status with glaucoma shunt success and postoperative complications. Methods: A retrospective single-center review was performed for older adults who underwent glaucoma drainage device implantation from January 2015 to July 2025. Included patients had a documented electronic frailty index (eFI) score and were followed for up to 1 year of follow-up. Partial surgical success was defined as an IOP of 5-21 mmHg with a ≥20% IOP reduction from baseline at 1 year; complete success additionally required absence of severe complications. Logistic regression assessed predictors of surgical success. Kaplan-Meier and Cox proportional hazards models evaluated time to postoperative complications. Results: Among 200 patients/eyes (mean age = 70.6 years), 60% were pre-frail or frail. At 1 year, 79% achieved partial success, and nearly two-thirds had no postoperative complications. Frail/pre-frail status was significantly associated with a higher risk of postoperative complications (HR = 1.90, 95% CI (1.07, 3.36), p = 0.027) though not with achieving partial success (OR = 1.49, 95% CI (0.72, 3.07)). There were no significant sociodemographic predictors of postoperative complication timing (all p > 0.05). Conclusions: Being pre-frail or frail meaningfully increased vulnerability to postoperative complications but was not associated with achieving partial or complete surgical success. The elevated complication risk highlights the importance of frailty assessment in preoperative planning for older adults. Future studies should evaluate how integrating frailty screening into perioperative discussions may optimize outcomes and support shared decision-making in aging patients undergoing glaucoma surgery.