The Impact of Frailty on Postoperative Outcomes in Neurosurgery: A Scoping Review

Introduction: Frailty, defined by a reduced physiological reserve, is increasingly recognized as a significant predictor of postoperative complications in neurosurgery. As neurosurgical procedures become increasingly complex, frail patients face elevated risks of adverse outcomes, highlighting the importance of assessing frailty’s impact across different neurosurgical subspecialties.

Methods: This scoping review systematically examined studies on frailty and postoperative outcomes in neurosurgery. Searches were conducted across multiple databases, including PubMed, Scopus, CINAHL, Embase, Web of Science, and the Cochrane Library, focusing on studies using validated frailty indices such as the Modified Frailty Index (mFI) and Risk Analysis Index (RAI). Studies involving adult patients undergoing brain, spine, vascular, or tumor surgeries were included. Of 1,039 articles screened, 386 studies met the inclusion criteria and were analyzed for frailty-related postoperative outcomes.

Results: The review indicated that frail patients undergoing neurosurgical procedures are more susceptible to postoperative complications, including increased rates of infections, prolonged hospital stays, and higher overall mortality. Frailty had a particularly notable impact in spine and tumor surgeries, where frail patients experienced more frequent readmissions and non-routine discharges. Additionally, frail patients in vascular neurosurgery were at higher risk for complications affecting functional recovery and longer-term outcomes.

Conclusion : Frailty is a critical factor in predicting postoperative outcomes in neurosurgery, underscoring the need for routine frailty assessments in preoperative planning. This review highlights gaps in the current literature regarding standardized frailty assessments, particularly in high-risk subspecialties. Developing predictive models and standardized protocols that incorporate frailty measures could improve surgical decision-making, enhance patient outcomes, and reduce healthcare costs. Future research should aim to establish guidelines for integrating frailty assessment into neurosurgical practice.