Table 3.
The association between frailty and hospital-related adverse events
| Authors | Type and incidence of AE n (%) Among non-frail and pre-frail patients (if reported) | Type and incidence of AE n (%) Among frail patients | Adjusted effect estimates for frailty as a predictor of AE | Confounders |
|---|---|---|---|---|
| Deiner et al. [42] |
Postoperative delirium (POD) Frailty index (FI): Non-frail 17/120 Pre-frail 32/190 Frailty phenotype (FP): Non-frail 8/64 Pre-frail 58/280 |
Postoperative delirium (POD) Frailty index (FI): Frail: 60/195 Frailty phenotype (FP): Frail: 43/160 |
Frailty index RR 1.84 [95% CI 1.05–3.21], p-value = 0.06 Frailty phenotype RR 1.33 [95% CI 0.63–2.80], p-value = 0.78 |
Adjusted for: age, sex, ASA class, surgical urgency, CCI, procedure complexity, and Modified Mini-Mental State |
| Esmaeeli et al. [27] |
Postoperative delirium (POD) Robust (frail 0): 7/174 Pre-frail (frail 1–2): 36/232 |
Postoperative delirium (POD) Frail (frail 3–5): 37/151 |
OR 1.33 (95% CI 1.02–1.72), p-value = 0.03 | Adjusted for: age, sex, marital status, cognitive score, Charlson comorbidity Index, falls in the past year, glomerular filtration rate, and ICU admission |
| Sieber et al. [29] |
Postoperative delirium (POD) Non-frail: 5/241 |
Postoperative delirium (POD) Frail: 10/83 |
OR 3.5 (95% CI 1.1–11.5), p-value = 0.0007 | Adjusted for: age and comorbidities |
| Joseph et al. [43] |
Non-Frail and pre-frail UTI: 9/217 Pneumonia: 7/217 Sepsis: 6/217 DVT/PE: 5/217 DIC: 2/217 |
Frail UTI: 13/133 Pneumonia: 12/133 Sepsis: 5/133 DVT/PE: 7/133 DIC: 2/133 |
Not reported | Not reported |
| Leung et al. [44] |
Postoperative delirium (POD) Pre-frail (frailty scores 1–2): 7/32 |
Postoperative delirium (POD) Frail (frailty score ≥ 3): 9/21 |
OR 1.84 (95% CI 1.07–3.15), with a p-value of 0.028 | Adjusted for: age, GDS score, and baseline cognitive function |
| Hanlon et al. [33] | The population of this study consisted of all frail individuals, with 365/397 (91.9%) frail patients receiving ≥ 1 inappropriate medication prescribed | Not reported | Not reported | |
| McEvoy et al. [30] |
Falls 0–1 deficit: 104/24,339 2 deficits: 181/8,717 3 deficits: 318/8,513 Pressure injury 0–1 deficit: 19/24,339 2 deficits: 17//8,717 3 deficits: 50//8,513 Delirium 0–1 deficit: 63/24,339 2 deficits: 202/8717 3 deficits: 426/8513 Pneumonia 0–1 deficit: 88/24,339 2 deficits: 104/8717 3 deficits: 219/8513 Thromboembolism 0–1 deficit: 33/24,339 2 deficits: 25/8717 3 deficits: 59/8513 |
4–12 deficits Falls: 217/3152 Pressure injury: 54/3152 Delirium: 351/3152 Pneumonia: 189/3152 Thromboembolism: 31/3152 |
4–12 deficits Falls: RR 15.33 (95% CI 12.1–19.42, p < 0.001) Pressure ulcers: RR 21.28 (95% CI 12.53–36.16, p < 0.001) Delirium: RR 40.88 (95% CI 31.21–52.55, p < 0.001) Pneumonia: RR 16.46 (95% CI 12.74–21.27, p < 0.001) Thromboembolism: RR 7.25 (95% CI 4.4–11.92, p < 0.001) |
Adjusted for: age and sex |
| Thillainadesan J et al. [26] |
Assessed by a FI Delirium: 6/116 Functional decline: 17/116 Constipation: 64/116 Fall: 3/116 Pressure injury: 2/116 Assessed by CFS Delirium: 6/105 Functional decline: 15/105 Constipation: 59/105 Fall: 3/105 Pressure injury: 2/105 |
Assessed by a FI Delirium: 9/34 Functional decline: 11/34 Constipation: 16/34 Fall: 3/34 Pressure injury: 0/34 Assessed by CFS Delirium: 10/45 Functional decline: 13/45 Constipation: 21/45 Fall: 3/45 Pressure injury: 0/45 |
Frailty Index (FI): Delirium: OR = 5.64 (95% CI 1.47–21.68) Functional decline: OR = 2.08 (95% CI 0.73–5.91) Clinical frailty scale (CFS): Delirium: OR = 4.21 (95% CI 1.14–15.50) Functional decline: OR = 1.39 (95% CI 0.50–3.88) |
Adjusted for: age, sex, Charlson comorbidity index (CCI), admission type and surgical management approach |
| Hubbard et al. [31] |
The study did not explicitly report the exact numbers of AE per frail vs non-frail patients Inpatient fall: 83/1418 Inpatient delirium: 321/1418 Inpatient pressure ulcer: 42/1418 Inpatient functional decline: 96/1418 |
Inpatient Falls: OR 1.29 (95% CI: 1.10–1.50) Per 0.1 FI increase. Delirium: OR 2.34 (95% CI: 2.08–2.63) Per 0.1 FI increase. Pressure Ulcers: OR 1.51 (95% CI: 1.23–1.87) Per 0.1 FI increase. Functional decline: OR 1.20 (95% CI: 1.04–1.40) Per 0.1 FI increase. | Adjusted for: age, gender, comorbidities, and baseline cognitive function | |
| Chan et al. [37] |
CFS 1–3 Delirium: 21 Venous thromboembolism: 1 Pneumonia: 2 UTI: 7 Myocardial injury: 11 Need for transfusion: 14 Pressure ulcer: 8 Fall: 1 |
CFS 4–9 Delirium: 240 Venous thromboembolism: 12 Pneumonia: 28 UTI: 49 Myocardial injury: 104 Need for transfusion: 121 Pressure ulcer: 116 Fall: 22 |
(CFS 4) OR 1.0 (95% CI 0.5–2.2), p-value: 0.974 (CFS 5) OR 2.1 (95% CI 0.9–4.8), p-value: 0.076 (CFS 6–9) OR: 4.8 (95% CI 2.1–10.8), p-value: < 0.001 |
Adjusted for: age, sex, time to surgery, and mode of anaesthesia |
| Dasgupta M et al. [41] |
Having at least one complication: EFS < 4: 5/51 EFS 4–7: 48/183 |
Having at least one complication: EFS > 7: 9/16 |
EFS > 7 Cardiac complication: OR 3.75 (95% CI 1.04–13.51) Pulmonary complication: OR 6.61 (95% CI 1.51–28.29) Delirium: OR 2.43 (95% CI 0.65–9.07) |
Adjusted for: age |
| Jung et al. [34] |
For CFS < 5 Total non-frail patients = 637 Delirium 1/637 Pressure ulcers 0/637 Falls 1/637 |
For CFS ≥ 5 Total frail patients = 379 Delirium 49/379 Pressure ulcers 26/379 Falls 5/379 |
Falls: OR = 1.39 (95% CI 0.74–2.60) Pressure ulcers: OR = 2.77 (95% CI 1.94–3.96) Delirium: OR = 2.56 (95% CI 1.98–3.31) |
Adjusted for: age and sex |
| Kim et al. [36] |
The study reported the total incidence of adverse events but did not specify the breakdown between non-frail and frail groups Total incidence of complications = 85 Poor oral intake 16/85 Voiding difficulty 14/85 Urinary tract infection 4/85 Delirium 3/85 Pneumonia 3/85 Postoperative hematoma 2/85 Acute kidney injury 1/85 Electrolyte imbalance 1/85 Sepsis 1/85 Cardiac arrest 1/85 Superficialwoundinfection1/85 , p |
K-FRAIL scale and any postoperative complication:OR = 0.130 (95% CI 0.039–0.222), p = 0.006 | Adjusted for: age, surgical invasiveness, and CCI | |
| Nowak et al. [35] |
Non-frail: Bleeding 9/54 Infection 6/54 arrhythmia 5/54 Acute kidney injury (AKI) 11/54 Delirium 2/54 Stroke/transient ischaemic attack (TIA) 1/54 Liver injury 0/54 Hypoglycaemia 1/54 Pre-frail: Bleeding 14/52 Infection 16/52 Arrhythmia 19/52 Acute kidney injury (AKI) 15/52 Delirium 6/52 Stroke/transient ischaemic attack (TIA) 2/52 Liver injury 6/52 Hypoglycaemia 0/52 |
Frail: Bleeding 31/68 Infection 37/68 Arrhythmia 54/68 Acute kidney injury (AKI) 39/68 Delirium 36/68 Stroke/transient ischaemic attack (TIA) 3/68 Liver injury 12/68 Hypoglycaemia 7/68 |
Bleeding: not reported Infection: OR = 3.3 (95% CI 1.6–7.0) Pneumonia/LRTI: OR = 2.5 (95% CI 1.1–5.8) UTI: OR = 4.8 (95% CI 1.8–12.5) Arrhythmia (only atrial fibrillation): OR = 3.5 (95% CI 1.3–9.3) AKI: OR = 2.6 (95% CI 1.2–5.3) Delirium: OR = 11.7 (95% CI 4.8–28.7) |
Adjusted for: age, BMI, atrial fibrillation, left ventricular ejection fraction, haemoglobin on admission, and invasive vs. conservative treatment |
| Chen et al. [39] |
Postoperative pulmonary complications (PPC) = 56 Non-frail: 20/56 |
Postoperative pulmonary complications (PPC) = 56 Frail: 30/56 |
Frailty: OR 6.33 (95% CI 2.45–16.37) | Adjusted for: age, sex, body mass index, current drinker, current smoker, hypertension, diabetes, coronary artery disease, asthma, chronic obstructive pulmonary disease, obstructive sleep apnoea, bronchiectasis, respiratory infection within the last month, forced expiratory volume in the first second (FEV1), FEV1/forced vital capacity (FVC), preoperative SpO2, haemoglobin, creatinine, operation time |
| Aceto et al. [40] |
Postoperative pulmonary complications (PPC) Non-frail: 1/11 |
Postoperative pulmonary complications (PPC) Frail: 10/11 |
Logistic regression showed that mFI were a predictor of PPCs (p = 0.0001) but the study did not report the OR | Not reported |
| Welch et al. [28] |
Postoperative delirium (POD) Fit (CFS 1–3): 15 out of 468 |
Postoperative delirium (POD) Frail (CFS 4–6): 134/796 Very frail (CFS 7–9): 67/201 |
Frail (CFS 4–6): OR = 4.80 (95% CI 2.63–8.74) Very frail (CFS 7–9): OR = 9.33 (95% CI 4.79–18.17) |
Adjusted for: age, sex, Charlson Comorbidity Index (CCI), admission type, and baseline cognitive status |
| Birkelbach et al. [38] |
Non-frail and pre-frail Pneumonia: 23/1051 Pulmonary embolism: 6/1051 Acute kidney injury: 57/1051 Cerebrovascular accident: 2/1051 Coma: 2/1051 Superficial wound infections: 26/1051 Deep wound infections: 15/1051 Urinary tract infection: 172/1051 Sepsis: 14/1051 Deep vein thrombosis: 12/1051 Myocardial infarction: 2/1051 Cardiac arrest: 3/1051 |
Frail Pneumonia: 5/135 Pulmonary embolism: 0/135 Acute kidney injury: 12/135 Cerebrovascular accident: 1/135 Coma: 2/135 Superficial wound infections: 8/135 Deep wound infections: 3/135 Urinary tract infection: 33/135 Sepsis: 4/135 Deep vein thrombosis: 2/135 Myocardial infarction: 2/135 Cardiac arrest: 4/135 |
Frail OR 2.08 (95% CI 1.21–3.60) p-value, 0.008 | Adjusted for: age, sex, body mass index, American Society of Anaesthesiologists Physical Status (ASA PS), surgical risk, type of anaesthesia, Charlson comorbidity index (CCI), surgical discipline, smoking status, polypharmacy, as well as preoperative creatinine levels and glomerular filtration rates (GFR) |
| Joosten et al. [32] |
Non-frail and pre-frail by CHS Delirium: 14/132 Fall: 10/132 Non-frail and pre-frail by SOF Delirium: 14/138 Fall: 12/138 |
Frail by CHS Delirium: 10/88 Fall: 8/88 Frail by SOF Delirium: 6/66 Fall: 5/66 |
CHS index Delirium OR 0.64 (95% CI 0.25–2.08) Fall OR 0.94 (95% CI 0.31–2.91) SOF index Delirium OR 0.81 (95% CI 0.21–3.2) Fall OR 0.71 (95% CI 0.21–2.4) |
Adjusted for: age, sex, education, number of comorbidities, ADLs, cognitive impairment, main diagnosis, haemoglobin, depression, and estimated Glomerular Filtration Rate |