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In older adults undergoing surgical fixation or arthroplasty following upper limb fractures, does frailty predict post-operative complications and mortality? A systematic review and meta-analysis
Date
2026-08-01
Abstract
Background: There is growing recognition of the role of clinical frailty and its impact on health outcomes in aging cohorts. Frailty may be associated with mortality and complications following fracture; however, its impact on upper limb outcomes has yet to be quantified. This systematic review aims to evaluate the association between pre-operative frailty and post-operative mortality and complications in adults undergoing surgical treatment for upper limb fractures. Secondary outcomes included reoperation, adverse discharge destination and length of stay. Methods: MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched on January 31, 2025, to identify studies that assessed pre-operative patient frailty and post-operative outcomes in adults following traumatic upper limb fractures. Data on 30- day mortality, post-operative complications, reoperation, hospital readmission, adverse discharge, Clavien-Dindo IV complications, and length of stay were extracted. Data were pooled using random-effects and fixed effects models for meta-analyses. Grading of Recommendations Assessment, Development and Evaluation assessment was used to assess the quality of available evidence. Results: Of the 4,013 records identified, 9 retrospective cohort studies were eligible for inclusion. Frailty was significantly associated with increased risk of 30-day mortality (odds ratio [OR] = 3.40, 95% confidence interval [CI] = 2.90-3.99, P < .001), post-operative complications (OR = 2.78, 95% CI = 1.99-3.88, P < .001), adverse discharge (OR = 2.96, 95% CI = 1.75-5.02, P < .001), and hospital readmission (OR = 3.73,
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Description
Publisher
Elsevier
Citation
JSES Reviews, Reports, and Techniques 6(3), 100764
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MacLeay_2026_Older.pdf
Adobe PDF, 2.34 MB
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Funding Information
Sustainable Development Goals
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License
Attribution-NonCommercial-ShareAlike 4.0 International