Frailty significantly raises the risk of death and readmission after pancreatic surgery, primarily through postoperative complications.

• 22.2% of 71,104 patients were frail, with 30-day mortality linked to frailty (aOR 1.29) and readmission (aOR 1.11).
• Complications mediated 80.72% of the frailty-mortality association, with unplanned reintubation and major infections among the top culprits.

Focus on preventing complications and enhancing post-operative care for frail patients to improve outcomes.