Frailty and Postoperative Pulmonary Complications: Implications for Emergency Physicians

A meta-analysis on frailty and PPC finds that older, frail patients undergoing pulmonary resection have a markedly higher risk of postoperative pulmonary complications, a key consideration for emergency physicians responsible for preoperative triage, perioperative optimization, and early complication recognition.

The review pooled 12 observational cohorts (n=394,947) using PPCs as the primary endpoint and produced a pooled odds ratio of approximately 2.96 for frail versus non‑frail patients.

Despite substantial between‑study heterogeneity (I^2 > 50%), results were consistent across subgroup and sensitivity analyses; the pooled estimate used a random‑effects model and maintained a uniform direction of effect.

Subgroup analyses highlighted the modified frailty index (mFI), particularly the mFI‑11, which showed stronger predictive performance (OR ≈ 3.47). The mFI frames frailty as deficit accumulation using comorbidity‑ and function‑based items that are readily obtainable from history or brief chart review, making it a practical, rapid risk‑stratification tool in the ED before transfer or operative planning.

Frailty was also associated with higher ICU admission rates, prolonged mechanical ventilation, greater in‑hospital morbidity, increased 30–90‑day readmissions, and persistent functional decline. When frailty is identified in surgical candidates presenting to the ED, heightened surveillance and expedited multidisciplinary assessment are appropriate clinical responses.

Practical perioperative measures for frail, high‑risk patients include targeted respiratory physiotherapy; documented incentive spirometry with explicit mobilization plans; aggressive pulmonary toilet in the immediate postoperative window; and brief prehabilitation when time allows before elective resections. Early involvement of anesthesiology and surgical teams to reconsider timing, approach, or enhanced postoperative respiratory support can be arranged from the ED. Evidence for frailty‑specific interventions remains limited—randomized trials are needed to determine which optimization packages most effectively reduce PPC risk.