Is Frailty Associated with Worse Outcomes After Major Liver Surgery? An Observational Case–Control Study

<b>Background</b>: The rate of morbidity after liver surgery is estimated at 30% and can be even higher when considering higher-risk subgroups of patients. Frailty is believed to better predict surgical outcomes by showcasing the patient's ability to withstand major surgical stress and selecting frail ones. <b>Methods</b>: This is a single-centre, observational case-control study on patients diagnosed with liver malignancies who underwent liver resections between 2013 and 2024. The five-item modified Frailty Index (mFI-5) was used to split patients into frail and non-frail. The two groups were compared in terms of preoperative, operative and postoperative outcomes using a chi-squared and logistic regression model. <b>Results</b>: A total of 230 patients were included and split into two groups: non-frail, NF, <i>n</i> = 90, and frail patients, F, <i>n</i> = 140. Overall, F patients had a higher rate of morbidity (<i>p</i> = 0.04) but with similar mortality and length of stay. When considering only major liver resections, F patients had a higher probability of posthepatectomy liver failure (LR 6.793, <i>p</i> = 0.009), postoperative bleeding (LR 9.541, <i>p</i> = 0.002) and longer ICU stay (LR 8.666, <i>p</i> = 0.003), with similar rates of bile leak, surgical site infections, length of stay and mortality. <b>Conclusions</b>: Frailty seems to be a solid predictor of posthepatectomy liver failure in patients undergoing major liver resections and is associated with a longer ICU stay. However, mortality and surgical morbidity seem to be comparable between frail and non-frail patients.