The impact of frailty on posttraumatic outcomes in older trauma patients: A systematic review and meta-analysis

BACKGROUND Frailty is a risk factor for mortality among the elderly. However, evidence from longitudinal studies linking trauma and frailty is fragmented, and a comprehensive analysis of the relationship between frailty and adverse outcomes is lacking. Therefore, we conducted a systematic review and meta-analysis to examine whether frailty is predictive of posttraumatic results including mortality, adverse discharge, complications, and readmission in trauma patients. METHODS This systematic review was registered with the PROSPERO international prospective register of systematic reviews. Articles in PubMed, Embase, and Web of Science databases from January 1, 1990, to October 31, 2019, were systematically searched. Articles in McDonald et al.'s study (J Trauma Acute Care Surg. 2016;80(5):824-834) and Cubitt et al.'s study (Injury2019;50(11):1795-1808) were included for studies evaluating the association between frailty and outcomes in trauma patients. Cohort studies, both retrospective and prospective, were included. Study population was patients suffering trauma injuries with an average age of 50 years and older. Multivariate adjusted odds ratios (ORs) were calculated through a random-effects model, and the Newcastle-Ottawa Quality Assessment Scale was used to assess studies. RESULTS We retrieved 11,313 entries. Thirteen studies including seven prospective and six retrospective cohort studies involving 50,348 patients were included in the meta-analysis. Frailty was a significant predictor of greater than 30-day mortality (OR, 2.41; 95% confidence interval [CI], 1.17-4.95;I-2= 88.1%), in-hospital and 30-day mortality (OR, 4.05; 95% CI, 2.02-8.11;I-2= 0%), postoperative complications (OR, 2.23; 95% CI, 1.34-3.73;I-2= 78.2%), Clavien-Dindo IV complications (OR, 4.16; 95% CI, 1.70-10.17;I-2= 0%), adverse discharge (OR, 1.80; 95% CI, 1.15-2.84;I-2= 78.6%), and readmission (OR, 2.16; 95% CI, 1.19-3.91;I-2= 21.5%) in elderly trauma patients. Subgroup analysis showed that prospective studies (OR, 3.06; 95% CI, 1.43-6.56) demonstrated a greater correlation between frailty and postoperative complications. CONCLUSION Frailty has significant adverse impacts on the occurrence of posttraumatic outcomes. Further studies should focus on interventions for patients with frailty. Given the number of vulnerable elderly trauma patients grows, further studies are needed to determine the accuracy of these measures in terms of trauma outcomes.