Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Launching: Thursday 12th December 2024
ADVANCED SEARCH
Log in
Top
Langenbeck's Archives of Surgery
Published in:

01-12-2024 | Cholecystectomy | Systematic Review

Frailty as a predictor of mortality and morbidity after cholecystectomy: A systematic review and meta-analysis of cohort studies

Authors: Mojtaba Niknami, Hamed Tahmasbi, Shahryar Rajai Firouzabadi, Ida Mohammadi, Seyed Ali Mofidi, Mohammadreza Alinejadfard, Aryan Aarabi, Samin Sadraei

Published in: Langenbeck's Archives of Surgery | Issue 1/2024

Login to get access

Abstract

Background

Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy.

Methods

In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle–Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model.

Results

Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65–18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51–4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52–8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08–13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91–4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates.

Conclusion

This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.
Appendix
Available only for authorised users
Literature
1.
Unalp-Arida A, Ruhl CE (2024) Burden of gallstone disease in the United States population: Prepandemic rates and trends. World J Gastrointest Surg 16(4):1130PubMedPubMedCentralCrossRef
2.
Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M et al (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26:2134–2164PubMedCrossRef
3.
Hu ASY, Menon R, Gunnarsson R, De Costa A (2017) Risk factors for conversion of laparoscopic cholecystectomy to open surgery–A systematic literature review of 30 studies. Am J Surg 214(5):920–930PubMedCrossRef
4.
Hussain A (2011) Difficult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparoscopy Endoscopy Percutaneous Tech 21(4):211–217CrossRef
5.
De la Serna S, Ruano A, Pérez-Jiménez A, Rojo M, Avellana R, García-Botella A et al (2019) Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients. Hpb 21(11):1570–6PubMedCrossRef
6.
Rose JB, Hawkins WG (2017) Diagnosis and management of biliary injuries. Curr Probl Surg 54(8):406–435PubMedCrossRef
7.
Ramírez-Giraldo C, Venegas-Sanabria LC, Rojas-López S, Avendaño-Morales V (2024) Outcomes after laparoscopic cholecystectomy in patients older than 80 years: two-years follow-up. BMC Surg 24(1):87PubMedPubMedCentralCrossRef
8.
Dua A, Aziz A, Desai SS, McMaster J, Kuy S (2014) National trends in the adoption of laparoscopic cholecystectomy over 7 years in the United States and impact of laparoscopic approaches stratified by age. Minimally Invasive Surgery 2014(1):635461PubMedPubMedCentral
9.
10.
Murphy MM, Ng S-C, Simons JP, Csikesz NG, Shah SA, Tseng JF (2010) Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient? J Am Coll Surg 211(1):73–80PubMedCrossRef
11.
Kanakala V, Borowski DW, Pellen MG, Dronamraju SS, Woodcock SA, Seymour K et al (2011) Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg 9(4):318–323PubMedCrossRef
12.
Fagenson AM, Powers BD, Zorbas KA, Karhadkar S, Karachristos A, Di Carlo A et al (2021) Frailty Predicts Morbidity and Mortality After Laparoscopic Cholecystectomy for Acute Cholecystitis: An ACS-NSQIP Cohort Analysis. J Gastrointest Surg 25(4):932–940PubMedCrossRef
13.
Vermeiren S, Vella-Azzopardi R, Beckwee D, Habbig A-K, Scafoglieri A, Jansen B et al (2016) Frailty and the prediction of negative health outcomes: a meta-analysis. J Am med Direct Assoc 17(12):1163-e1-e17
14.
Murphy PB, Savage SA, Zarzaur BL (2020) Impact of patient frailty on morbidity and mortality after common emergency general surgery operations. J Surg Res 247:95–102PubMedCrossRef
15.
Louwers L, Schnickel G, Rubinfeld I (2016) Use of a simplified frailty index to predict Clavien 4 complications and mortality after hepatectomy: analysis of the National Surgical Quality Improvement Project database. Am J Surg 211(6):1071–1076PubMedCrossRef
16.
Obeid NM, Azuh O, Reddy S, Webb S, Reickert C, Velanovich V et al (2012) Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg 72(4):878–883PubMedCrossRef
17.
Saxton A, Velanovich V (2011) Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg 253(6):1223–1229PubMedCrossRef
18.
Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M (2009) Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr 48(1):78–83PubMedCrossRef
19.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M157PubMedCrossRef
20.
Rockwood K (2005) Frailty and its definition: a worthy challenge. J Am Geriatrics Soc 53(6):1069–1070CrossRef
21.
Farhat JS, Velanovich V, Falvo AJ, Horst HM, Swartz A, Patton JH Jr et al (2012) Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72(6):1526–1531PubMedCrossRef
22.
Richards SJ, Frizelle FA, Geddes JA, Eglinton TW, Hampton MB (2018) Frailty in surgical patients. Int J Colorectal Dis 33:1657–1666PubMedCrossRef
23.
Maxwell CA, Patel MB, Suarez-Rodriguez LC, Miller RS (2019) Frailty and prognostication in geriatric surgery and trauma. Clin Geriatr Med 35(1):13–26PubMedCrossRef
24.
Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H (2017) FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. J Am Med Dir Assoc 18(12):1082–1086PubMedPubMedCentralCrossRef
25.
Chen CCH, Yang YT, Lai IR, Lin BR, Yang CY, Huang J et al (2019) Three nurse-administered protocols reduce nutritional decline and frailty in older gastrointestinal surgery patients: a cluster randomized trial. J Am Med Direct Assoc 20(5):524–93. e3CrossRef
26.
Hogan DB, Maxwell CJ, Afilalo J, Arora RC, Bagshaw SM, Basran J et al (2017) A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research. Canadian Geriatrics J 20(1):22CrossRef
27.
Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210(6):901–908PubMedCrossRef
28.
Hewitt J, Long S, Carter B, Bach S, McCarthy K, Clegg A (2018) The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age Ageing 47(6):793–800PubMedCrossRef
29.
Vermeiren S, Vella-Azzopardi R, Beckwée D, Habbig AK, Scafoglieri A, Jansen B et al (2016) Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc 17(12):1163.e1-e17CrossRef
30.
Shafiee A, Arabzadeh Bahri R, Rajai S, Ahoopai M, Seighali N, Amini MJ (2023) Frailty as a predictor of adverse outcomes in burn patients: a systematic review. BMC Geriatr 23(1):680PubMedPubMedCentralCrossRef
31.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906PubMedCrossRef
32.
33.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J et al (2011) GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64(4):383–94PubMedCrossRef
34.
Deiner SG, Marcantonio ER, Trivedi S, Inouye SK, Travison TG, Schmitt EM et al (2024) Comparison of the frailty index and frailty phenotype and their associations with postoperative delirium incidence and severity. J Am Geriatr Soc 72(6):1781–1792PubMedCrossRef
35.
Pereira AA, Borim FSA, Aprahamian I, Neri AL (2019) Comparison of Two Models of Frailty for the Prediction of Mortality in Brazilian Community-Dwelling Older Adults: The FIBRA Study. J Nutr Health Aging 23(10):1004–1010PubMedCrossRef
36.
Romero-Ortuno R (2013) An alternative method for Frailty Index cut-off points to define frailty categories. Eur Geriatric Med 4(5):299–303CrossRef
37.
Porgo TV, Moore L, Tardif PA (2016) Evidence of data quality in trauma registries: A systematic review. J Trauma Acute Care Surg 80(4):648–658PubMedCrossRef
38.
Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2014) Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 20(46):17626–17634PubMedPubMedCentralCrossRef
39.
Sedgwick P (2013) Meta-analyses: heterogeneity and subgroup analysis. BMJ : British Medical Journal 346:f4040CrossRef
40.
41.
Haddaway NR, Page MJ, Pritchard CC, McGuinness LA (2022) PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev 18:e1230. https://​doi.​org/​10.​1002/​cl2.​1230
42.
Rosa F, Covino M, Russo A, Salini S, Forino R, Della Polla D et al (2023) Frailty assessment as independent prognostic factor for patients?65 years undergoing urgent cholecystectomy for acute cholecystitis. Dig Liver Dis 55(4):505–512PubMedCrossRef
43.
Lasithiotakis K, Petrakis J, Venianaki M, Georgiades G, Koutsomanolis D, Andreou A et al (2013) Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients. Surg Endosc Other Interv Tech 27(4):1144–1150
44.
45.
Mastalerz K, Kenig J, Olszewska U, Michalik C (2018) The Surgical Apgar Score and frailty as outcome predictors in short- and long-term evaluation of fit and frail older patients undergoing elective laparoscopic cholecystectomy - a prospective cohort study. Videosurg Other Miniinvasive Tech 13(3):350–357PubMedPubMedCentralCrossRef
46.
Lee DU, Fan GH, Hastie DJ, Addonizio EA, Suh J, Wang E et al (2022) The impact of frailty on the postoperative outcomes of patients undergoing cholecystectomy: propensity score matched analysis of 2011–2017 US hospitals. HPB 24(1):130–140PubMedCrossRef
47.
Lorenzon L, Costa G, Massa G, Frezza B, Stella F, Balducci G (2017) The impact of frailty syndrome and risk scores on emergency cholecystectomy patients. Surg Today 47(1):74–83PubMedCrossRef
48.
Agathis AZ, Bangla VG, Divino CM (2023) Role of mFI-5 in predicting geriatric outcomes in laparoscopic cholecystectomy. Am J Surg 226(5):697–702PubMedCrossRef
49.
Panayi AC, Orkaby AR, Sakthivel D, Endo Y, Varon D, Roh D et al (2019) Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. Am J Surg 218(2):393–400PubMedCrossRef
50.
Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH et al (2002) Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 162(20):2333–2341PubMedCrossRef
51.
Vatic M, von Haehling S, Ebner N (2020) Inflammatory biomarkers of frailty. Exp Gerontol 133:110858PubMedCrossRef
52.
53.
54.
Marzetti E, Calvani R, Cesari M, Buford TW, Lorenzi M, Behnke BJ et al (2013) Mitochondrial dysfunction and sarcopenia of aging: from signaling pathways to clinical trials. Int J Biochem Cell Biol 45(10):2288–2301PubMedPubMedCentralCrossRef
55.
56.
Richards SJG, Frizelle FA, Geddes JA, Eglinton TW, Hampton MB (2018) Frailty in surgical patients. Int J Colorectal Dis 33(12):1657–1666PubMedCrossRef
57.
Khoo B, Boshier PR, Freethy A, Tharakan G, Saeed S, Hill N et al (2017) Redefining the stress cortisol response to surgery. Clin Endocrinol 87(5):451–458CrossRef
58.
Fernando SM, McIsaac DI, Rochwerg B, Bagshaw SM, Muscedere J, Munshi L et al (2019) Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Med 45(12):1742–1752PubMedCrossRef
59.
Mahalingam M, Moore JX, Donnelly JP, Safford MM, Wang HE (2019) Frailty Syndrome and Risk of Sepsis in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort. J Intensive Care Med 34(4):292–300PubMedCrossRef
60.
Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D et al (2017) The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med 43(8):1105–1122PubMedPubMedCentralCrossRef
61.
Kenig J, Wałęga P, Olszewska U, Konturek A, Nowak W (2016) Geriatric Assessment as a qualification element for elective and emergency cholecystectomy in older patients. World J Emerg Surg 11:36PubMedPubMedCentralCrossRef
62.
Mastalerz K, Kenig J, Olszewska U, Michalik C (2018) The Surgical Apgar Score and frailty as outcome predictors in short- and long-term evaluation of fit and frail older patients undergoing elective laparoscopic cholecystectomy - a prospective cohort study. Wideochir Inne Tech Maloinwazyjne 13(3):350–357PubMedPubMedCentral
63.
Martin FC, O’Halloran AM (2020) Tools for Assessing Frailty in Older People: General Concepts. Adv Exp Med Biol 1216:9–19PubMedCrossRef
64.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495PubMedPubMedCentralCrossRef
65.
Rockwood K, Howlett SE, MacKnight C, Beattie BL, Bergman H, Hébert R et al (2004) Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci 59(12):1310–1317PubMedCrossRef
66.
Ogata T, Sadakari Y, Nakane H, Koikawa K, Kanno H, Kohata R et al (2023) The five-item modified frailty index predicts long-term outcomes in elderly patients undergoing colorectal cancer surgery. World J Surg Oncol 21(1):268PubMedPubMedCentralCrossRef
67.
Jones D, Song X, Mitnitski A, Rockwood K (2005) Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians. Aging Clin Exp Res 17(6):465–471PubMedCrossRef
68.
Hatip Ünlü E, Fatih Doğu G, Yücel YÜ C.E, Jülide S.K, Banu Ç E, Kemal Tolga S (2022) Comparison of the modified 5-item frailty index with the american society of anesthesiologists classification and charlson age comorbidity index for predicting postoperative outcomes in geriatric patients: a prospective observational study. Türk Geriatri Dergisi 25(4):611–621. https://​doi.​org/​10.​31086/​tjgeri.​2022.​320
69.
Tran DTT, Tu JV, Dupuis JY, Bader Eddeen A, Sun LY (2018) Association of Frailty and Long-Term Survival in Patients Undergoing Coronary Artery Bypass Grafting. J Am Heart Assoc 7(15):e009882PubMedPubMedCentralCrossRef
70.
Rosa F, Covino M, Russo A, Salini S, Forino R, Della Polla D et al (2023) Frailty assessment as independent prognostic factor for patients >/=65 years undergoing urgent cholecystectomy for acute cholecystitis. Dig Liver Dis 55(4):505–512PubMedCrossRef
71.
Aucoin SD, Hao M, Sohi R, Shaw J, Bentov I, Walker D et al (2020) Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery: A Systematic Review and Meta-analysis. Anesthesiology 133(1):78–95PubMedCrossRef
72.
Lasithiotakis K, Petrakis J, Venianaki M, Georgiades G, Koutsomanolis D, Andreou A et al (2013) Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients. Surg Endosc 27(4):1144–1150PubMedCrossRef
73.
Kuy S, Sosa JA, Roman SA, Desai R, Rosenthal RA (2011) Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg 201(6):789–796PubMedCrossRef
74.
Rosa F, Covino M, Russo A, Salini S, Forino R, Della Polla D et al (2023) Frailty assessment as independent prognostic factor for patients≥ 65 years undergoing urgent cholecystectomy for acute cholecystitis. Dig Liver Dis 55(4):505–512PubMedCrossRef
75.
Mastalerz K, Kenig J, Olszewska U, Michalik C (2018) The Surgical Apgar score and frailty as outcome predictors in short-and long-term evaluation of fit and frail older patients undergoing elective laparoscopic cholecystectomy–a prospective cohort study. Videosurg Other Miniinvasive Tech 13(3):350–357PubMedPubMedCentralCrossRef
76.
Asmar S, Bible L, Obaid O, Anand T, Chehab M, Ditillo M et al (2021) Frail geriatric patients with acute calculous cholecystitis: Operative versus nonoperative management? J Trauma Acute Care Surg 91(1):219–225PubMedCrossRef
77.
Janssen ER, Hendriks T, Natroshvili T, Bremers AJ (2020) Retrospective analysis of non-surgical treatment of acute cholecystitis. Surg Infect 21(5):428–432CrossRef
78.
Chattopadhyay K, Das R (2020) Laparoscopic and open cholecystectomy: a comparative study. Int J Surg Sci 4(1):427–430CrossRef
79.
Osei-Bordom D, Hall L, Hodson J, Joshi K, Austen L, Bartlett D et al (2022) Impact of Frailty on Short-Term Outcomes After Laparoscopic and Open Hepatectomy. World J Surg 46(10):1CrossRef
Metadata
Title
Frailty as a predictor of mortality and morbidity after cholecystectomy: A systematic review and meta-analysis of cohort studies
Authors
Mojtaba Niknami
Hamed Tahmasbi
Shahryar Rajai Firouzabadi
Ida Mohammadi
Seyed Ali Mofidi
Mohammadreza Alinejadfard
Aryan Aarabi
Samin Sadraei
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Keyword
Cholecystectomy
Published in
Langenbeck's Archives of Surgery / Issue 1/2024
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-024-03537-z

Other articles of this Issue 1/2024

A new approach for perioperative parathyroid hormone (PTH) measurement to establish cure in patients with primary hyperparathyroidism

Comparison of the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy

Stage-by-stage analysis of the effect of blood transfusion on survival after curative hepatectomy for hepatocellular carcinoma—a retrospective study

Robotic assisted surgery reduces ergonomic risk during minimally invasive colorectal resection: the VOLCANO randomised controlled trial

Prognostic value of combined preoperative inflammatory marker neutrophil–lymphocyte ratio and platelet distribution width in patients with gallbladder carcinoma

Laparoscopic transverse abdominis plane block: how I do it and a cost efficiency analysis

SPONSORED

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

  • Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by:
  • Viatris
Developed by: Springer Healthcare
Watch now
Image Credits