Frailty, a "syndrome of loss of reserves," is a decade old concept. Initially it was
used mainly in geriatrics but lately its use has been extended into other specialties
including surgery. Our main objective was to examine the association between frailty
and mortality, between frailty and length of hospital stay (LOS) and frailty and readmission
within 30 days in the emergency surgical population.Studies reporting on frailty in
the emergency surgical population were eligible. MEDLINE (via PubMed), EMBASE, Scopus,
CENTRAL, and Web of Science were searched with terms related to acute surgery and
frail*. We searched for eligible articles without any restrictions on the 2nd of November
2020. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95%
confidence intervals (CI), using a random effect model. Risk of bias assessment was
performed according to the recommendations of the Cochrane Collaboration. As the finally
selected studies were either prospective or retrospective cohorts, the "Quality In
Prognosis Studies" (QUIPS) tool was used.At the end of the selection process 21 eligible
studies with total 562.070 participants from 8 countries were included in the qualitative
and the quantitative synthesis. Patients living with frailty have higher chance of
dying within 30 days after an emergency surgical admission (OR: 1.99; CI: 1.76-2.21;
p < 0.001). We found a tendency of increased LOS with frailty in acute surgical patients
(WMD: 4.75 days; CI: 1.79-7.71; p = 0.002). Patients living with frailty have increased
chance of 30-day readmission after discharge (OR: 1.36; CI: 1.06-1.75; p = 0.015).Although
there is good evidence that living with frailty increases the chance of unfavorable
outcomes, further research needs to be done to assess the benefits and costs of frailty
screening for emergency surgical patients.The review protocol was registered on the
PROSPERO International Prospective Register of Systematic Reviews (CRD42021224689).
