Impact of frailty on adverse outcomes in patients with abdominal aortic aneurysm undergoing surgery: a systematic review and meta-analysis

•The prevalence of frailty in AAA patients ranged between 2.3% and 34.6%.•AAA patients with frailty had a 3.20-fold higher risk of short-term death.•AAA patients with frailty conferred a 2.86-fold higher risk of long-term all-cause mortality.•AAA patients with frailty had a 2.19-fold higher risk of postoperative complications.•Lack of standardized definition of frailty is an important limitation. To explore the prognostic role of frailty in patients with abdominal aortic aneurysm (AAA) by conducting this systematic review and meta-analysis We conducted an extensive literature search on PubMed, Web of Sciences, and Embase databases to identify studies that reported the association of frailty with postoperative complications, reintervention, or all-cause mortality in patients with AAA after surgery. Short-term mortality was defined by a combination of in-hospital and 30-day death. Seven cohort studies reporting on 9 articles with 323,788 AAA patients were included. The reported prevalence of frailty in AAA patients ranged between 2.3% and 34.6%. Pooling the results revealed that frailty was significantly associated with a higher risk of short-term all-cause mortality (adjusted risk ratios [RR] 3.20; 95% confidence intervals [CI] 1.95–5.26), long-term all-cause mortality (adjusted RR 2.86; 95% CI 2.57–3.17), and postoperative complications (adjusted RR 2.19; 95% CI 1.50–3.20) compared to non-frail individuals. However, there was no clear association between frailty and reintervention (HR 1.44; 95% CI 0.97–2.16). Frailty independently predicts the short and long-term survival as well as postoperative complications in patients with AAA undergoing surgery. Assessing frail status may potentially enhance surgical decision-making for these patients.