Impact of frailty on outcomes of pancreatic surgery: a systematic review and meta-analysis

Objective Frailty is being recognized as a risk factor for adverse outcomes after various surgical procedures. However, its impact on pancreatic surgery outcomes remains uncertain. We hereby reviewed evidence on the difference in the risk of complications and mortality between frail and non-frail patients undergoing pancreatic surgery. Methods PubMed, Embase, Scopus, and Web of Science were searched from 1 st January 1980 to 17 th June 2025, for relevant studies. The endpoints of the study were all complications, Clavien-Dindo grade ≥3 (CD ≥ 3) complications, reoperation, and readmissions. Random-effect meta-analysis was conducted. Results A total of 11 studies were included. A pooled analysis revealed that frailty was associated with an increased risk of all complications in patients undergoing pancreatic surgery (OR: 1.51, 95% CI: 1.01–2.24, I 2 = 61%). Meta-analysis showed no significant difference between frail and non-frail patients for CD ≥ 3 complications (OR: 1.34, 95% CI: 0.86, 2.09 I 2 = 31%), readmission (OR: 1.41, 95% CI: 0.75, 2.62 I 2 = 0%) and reoperation (OR: 2.32, 95% CI: 0.63, 8.50 I 2 = 0%). However, frail patients had a significantly higher risk of short-term (OR: 2.54, 95% CI: 1.39, 4.61, I 2 = 50%) mortality as compared to non-frail patients after pancreatic surgery. Sensitivity and subgroup analysis generated mixed results. Conclusion The presence of preoperative frailty may lead to increased risk of short-term mortality and morbidity in patients undergoing pancreatic surgery. Frailty was not associated with major complications, readmission, or reoperations. However, results must be interpreted with caution owing to limited data and high inter-study heterogeneity. Systematic review registration https://www.crd.york.ac.uk/prospero/ , CRD420251049842.