Incidence and predictors of postoperative complications in elderly surgical patients: a systematic review and meta-analysis

Background Postoperative complication rates are higher for older adults undergoing surgery due to age-related functional decline, diminished physiological reserve, and multimorbidity. However, data on the incidence and predictors of these complications across different geographical areas and surgical specialties are inadequate. To aid perioperative risk stratification and improve clinical outcomes, this systematic review and meta-analysis aims to compile recent information on the incidence and predictors of postoperative complications in elderly surgical patients. Methods This systematic review and meta-analysis is registered in PROSPERO (CRD420251117160) and was conducted in accordance with PRISMA 2020 principles. It included English-language observational studies reporting on the incidence and/or predictors of postoperative complications in patients aged 60 years and older. A comprehensive search was performed using Google Scholar, ScienceDirect, and PubMed/MEDLINE. Joanna Briggs Institute (JBI), and results regarding incidence and predictors were narratively synthesized to provide a concise summary of the available data. Results In 29 studies, the pooled incidence of postoperative complications in elderly surgical patients was 40.07% (95% CI 27.99–52.15%; p < 0.001). The strongest independent predictors of these complications were ASA-PS III (OR 3.78; 95% CI 2.79–4.76), emergency surgery (OR 3.30; 95% CI 2.27–4.33), frailty (OR 2.41; 95% CI 1.89–2.94), hypoalbuminemia (OR 4.71; 95% CI 2.30–7.12), and renal failure (OR 2.65; 95% CI 2.22–3.65). Conclusion and recommendation The rate of postoperative complications is high among elderly surgical patients. Improving surgical outcomes requires early identification of high-risk adults and the application of evidence-based geriatric perioperative care.