Frailty among patients undergoing breast reconstruction surgery: A systematic review and meta-analysis

Background We conducted a systematic review and meta-analysis to evaluate the predictive value of frailty for predicting post-surgical complications in patients undergoing breast reconstruction surgery. Methods MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched for relevant studies up to 13 September 2022. A systematic review and meta-analysis of studies was performed based on the PRISMA 2020 statement criteria. Results Nine studies were included in this study. The rates of overall complications (OR 1.52, 95% CI 1.17 to 1.97, I2= 76%; p= 0.002), wound complications (OR 1.87, 95% CI 1.56 to 2.26, I2 = 16%; p< 0.0001), readmissions (OR 1.94, 95% CI 1.61 to 2.34, I2 = 15%; p< 0.0001), and reoperations (OR 1.41, 95% CI 1.12 to 1.77, I2 = 39%; p= 0.003) were significantly greater in frail patients undergoing breast reconstruction surgery. Furthermore, compared to non-frail patients, this difference remained significantly higher among pre-frail individuals (overall complications: (OR 1.27, 95% CI 1.13 to 1.41, I2= 67%; p< 0.001), wound complications: (OR 1.48, 95% CI 1.33 to 1.66, I2 = 24%; p< 0.0001), readmission: (OR 1.47, 95% CI 1.34 to 1.61, I2 = 0%; p< 0.0001), reoperation: (OR 1.32, 95% CI 1.23 to 1.42, I2 = 0%; p< 0.0001)). We found that frail patients undergoing immediate autologous reconstruction surgery are the most vulnerable to experiencing postoperative overall complications. Conclusion Frailty is a strong predictor of postsurgical complications after breast reconstruction surgery in frail and pre-frail patients. The most frailty index utilized was the modified five-item frailty index (mFI-5). More research is needed on this topic to assess the utility of frailty in practice, especially in countries other than the United States. DATA AVAILABILITY STATEMENT Data sharing is available by contacting corresponding author.