Frailty is an independent marker of post-operative mortality following colorectal cancer resection surgery in older adults

Abstract Introduction Frailty is associated with impaired post-operative outcome after colorectal cancer surgery. Despite this, frailty assessments are not a part of standard colorectal cancer care in Sweden. This study aims to explore the presence of frailty in patients aged ≥ 70 and to explore differences in post-operative mortality and complications between frail and non-frail older adults, in a Swedish setting. Method Data was retrospectively obtained from the Swedish Colorectal Cancer Registry. A retrospective frailty assessment, using Clinical Frailty Scale (CFS-9) was made on a randomly selected cohort of 500 patients aged ≥ 70 and operated for colorectal cancer during 2016-2020, in Region Västra Götaland (VGR). Multivariable logistic regression analyses were made and adjusted for age, sex, tumour location, stage according to TNM, ASA-classification and surgical prioritisation (elective/urgent) and comparing frail and non-frail patients. Result 56 % of patients were considered frail (CFS-9 score ≥4). Frail elderly patients had higher 90-day mortality rate (OR 4.97 [95 % CI 1.06-23.28], p 0.042)], one-year mortality rate (OR 4.39 [95% CI 1.86-10.34], p 0.0007), longer length of stay in hospital (7.63 vs 11.0 days, p < 0.001), were more often treated in an intensive care unit (ICU) postoperatively and more often discharged to a nursing home facility. Discussion Frailty is a common condition in patients aged ≥ 70 and frail patients suffer increased risk of post-operative mortality following colorectal cancer surgery, both in short- and long term. Individually targeted treatment preoperatively could be a way to decrease the postoperative risks for this patient group.