Impact of pre-operative frailty on short-term outcomes of ovarian cancer: a systematic review and meta-analysis

Frailty has been linked to adverse outcomes after numerous surgical procedures; however, its utility for ovarian cancer patients undergoing surgery remains undefined. We systematically reviewed literature to examine the risk of short-term adverse events in surgically treated ovarian cancer patients based on the presence of frailty. Web of Science, Embase, PubMed and Scopus databases were searched for all observational studies published from the inception of the databases to 14 August 2025. Data on all complications, major complications, minor complications, mortality and readmission were pooled in a random effects model. Eleven studies were included. Meta-analysis showed that the presence of frailty was associated with a statistically significant increase in the risk of all complications (OR: 1.61 95% CI: 1.35, 1.92 I2 = 44%) and major complications (OR: 1.80 95% CI: 1.31, 2.47 I2 = 54%) in patients with ovarian cancer. Meta-analysis showed that the presence of frailty did not significantly increase the risk of minor complications (OR: 1.39 95% CI: 0.93, 2.07 I2 = 0%) or mortality (OR: 1.12 95% CI: 0.59, 2.12 I2 = 0%) in patients with ovarian cancer. However, the risk of readmission was increased with the presence of frailty (OR: 1.43 95% CI: 1.11, 1.84 I2 = 0%). Subgroup analysis conducted based on location, frailty assessment tools, including only stage III/IV disease, and reporting of adjusted data demonstrated mixed results. Meta-regression analysis showed that a higher surgical complexity score was associated with increased risk of major complications. Pretreatment frailty seems to be associated with increased risk of complications in ovarian cancer patients undergoing surgery. However, due to minimal evidence, no clear association could be found between frailty and risk of short-term mortality and minor complications. Further prospective, adequately powered studies using similar frailty assessment tools and cut-offs are needed from different regions of the world to provide better evidence.