Pre‐operative frailty is predictive of adverse post‐operative outcomes in colorectal cancer patients

• Published in: ANZ journal of surgery Vol. 91; no. 3; pp. 379 - 386
• Main Authors: Richards, Simon J. G., Cherry, Tiffany J., Frizelle, Frank A., Eglinton, Tim W.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.03.2021; Blackwell Publishing Ltd
• Subjects: Aged; Cancer; Cancer surgery; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - surgery; colorectal surgery; Complications; Decision making; Frail Elderly; Frailty; Frailty - complications; Frailty - epidemiology; Geriatric Assessment; Humans; Length of Stay; Older people; Optimization; Patients; Postoperative Complications - epidemiology; post‐operative outcome; Prospective Studies; Quality of Life; Regression analysis; Risk assessment; Risk Factors; Surgery; Target recognition; frailty; colorectal surgery; colorectal cancer; post-operative outcome
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.16319

Background An increasing number of elderly patients are presenting for elective surgery. Pre‐operative risk assessment in this population is inexact due to the complex interplay between age, comorbidity and functional status. Frailty assessment may provide a surrogate measure of a patient's physiological reserve and aid operative decision‐making. The aim of this study is to determine the association between pre‐operative frailty, as assessed using the Edmonton Frail Scale, and post‐operative outcomes in elderly patients undergoing elective colorectal cancer surgery. Methods A prospective analysis of 86 patients over the age of 65 undergoing elective colorectal cancer surgery at a tertiary centre between October 2017 and October 2018 was performed. Frailty assessment was conducted pre‐operatively using the Edmonton Frail Scale. Primary outcomes included length of stay and post‐operative complication rates. Multivariable logistic regression analyses were used to determine the influence of frailty on post‐operative outcomes including mortality, prolonged hospital admission, complication rates and quality of life. Results Of 86 patients, 12 (14.0%) were identified as frail. Frailty was associated with a significantly increased median length of stay (20 days versus 6 days, incidence rate ratio 2.83, P < 0.01) and a significantly increased risk of major post‐operative complications (50.0% versus 6.7%, odds ratio 13.8, P < 0.01). Frailty was not associated with a significant reduction in quality of life scores at 30 and 90 days post‐operatively. Conclusion Frailty is associated with adverse post‐operative outcomes in elderly patients undergoing elective colorectal cancer surgery. Frailty assessment is an important component of pre‐operative risk assessment and may identify targets for pre‐operative optimisation. Perioperative risk assessment in elderly patients is difficult due to physiological heterogeneity in this group, and frailty assessment may be more useful than traditional assessment tools. In this paper, we have shown the presence of frailty to be strongly associated with adverse post‐operative outcomes and to be a stronger predictor than other tools such as American Society of Anesthesiologists physical status classfication.