Impact of preoperative frailty on venous thromboembolism risk following total hip and knee arthroplasty: a meta-analysis.

BACKGROUND: Frailty is commonly observed in older adults and may elevate the risk of venous thromboembolism (VTE) following total hip arthroplasty (THA) or total knee arthroplasty (TKA). This meta-analysis elucidates the association between frailty and the risk of postoperative VTE, encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), among patients undergoing THA or TKA. MATERIALS AND METHODS: A systematic search was conducted across PubMed, Embase, and Web of Science through 22 August 2024, to identify relevant observational studies with longitudinal follow-up. Eligible studies reported on frailty status preoperatively and subsequent postoperative VTE events. We synthesized data using random-effects models that accounted for heterogeneity and performed subgroup analyses based on the type of surgery and duration of follow-up. RESULTS: Our meta-analysis included fourteen cohort studies covering 2,218,293 patients. Analysis of univariate results from sixteen datasets showed that frailty was associated with an increased risk of VTE post-THA/TKA (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.84 to 2.93, p <0.001). This association remained consistent across primary and revision THA/TKA surgeries. Frail patients exhibited heightened risk of DVT (OR: 1.41, 95% CI: 1.12 to 1.78, p  = 0.004) and PE (OR: 1.59, 95% CI: 1.38 to 1.84, p <0.001). Subgroup analyses revealed that the link with PE was more pronounced in studies with follow-ups of 90 days (OR: 7.42) than in studies with other follow-up durations (mostly 30 days). Multivariate analysis confirmed that frailty independently predicted increased risks of DVT (OR: 1.69) and PE (OR: 1.57). CONCLUSION: Preoperative frailty significantly heightens the risk of postoperative VTE, DVT, and PE in patients undergoing THA or TKA.