Review Proposes Pancreas-Specific Framework Beyond Frailty for Surgical Risk Assessment

A systematic review published in the World Journal of Surgery evaluated frailty assessment in adults undergoing pancreatic resection. Following PRISMA 2020 guidelines, the authors searched five databases for studies published between January 2016 and April 2026. Twenty studies involving more than 150,000 patients were included, with findings synthesized primarily narratively because of substantial methodological heterogeneity.

The Modified Frailty Index (mFI) was the most commonly used instrument, followed by the Hospital Frailty Risk Score. Frailty was generally associated with postoperative morbidity, mortality, longer hospitalization, non-home discharge, and functional decline. An exploratory meta-analysis restricted to adjusted estimates from mFI studies found associations with major morbidity (pooled OR 1.60, 95% CI 1.27–2.01; I² = 53%) and short-term mortality (pooled OR 1.31, 95% CI 1.16–1.48; I² = 0%). Confounding adjustment varied, and some findings in the broader review relied solely on unadjusted comparisons.

The authors support incorporating frailty into preoperative evaluation but note that existing tools largely reflect comorbidity and incompletely capture nutrition, sarcopenia, obesity, and pancreas-specific operative risk. Their proposed PANFRAIL framework integrates these dimensions with procedural complexity. It remains a conceptual model rather than a validated clinical tool, and the pooled associations are considered hypothesis-generating. This report is based on the abstract; full text was unavailable.