Mapping the future: Two decades of insights into preoperative frailty assessment in elderly patients

The assessment of preoperative frailty (PFA) has become an essential instrument for forecasting postoperative outcomes in elderly patients (EP). However, there is a notable absence of comprehensive bibliometric analyses that chart global research trends in this area. This study systematically investigates the intellectual landscape, key research areas, and evolving paradigms in PFA research for EP from 2005 to 2025.

Publications from 2005 to 2025 were retrieved from the Web of Science Core Collection using a comprehensive search strategy that integrated terms associated with EP and PFA. Analytical tools VOSviewer 1.6.19 and CiteSpace 6.4.R1 were utilized to examine annual publication trends, country and institutional contributions, journal and authorship patterns, co-citation networks, and keyword emergence.

Among 2108 English-language full-text articles and reviews, the annual publication output increased quadratically, reaching its peak in 2024. The United States led in research productivity (805 papers; 22,402 citations), followed by Europe. Harvard Medical School was the most prolific institution, contributing 59 papers. JAMA Surgery garnered the highest number of citations (2399) and had the highest impact factor (14.9). The keywords "sarcopenia," "depression," and "malnutrition" demonstrated the most significant recent citation bursts, indicating emerging research hotspots.

PFA in EP is rapidly expanding, with a predominant contribution from North American and European research. Future priorities should focus on incorporating sarcopenia, depression, and malnutrition into standardized preoperative protocols to facilitate personalized risk stratification and the development of tailored prehabilitation strategies.