Preoperative Cognitive Function and Physical Frailty Predict Decision Satisfaction and Postoperative Adherence in Older Gynecologic Oncology Patients: A Prospective Observational Study

With increasing life expectancy, a growing proportion of patients undergoing surgery for gynecologic cancers are older adults, underscoring the need for reliable predictors of postoperative recovery and patient engagement. Cognitive function and physical frailty are recognized determinants of surgical outcomes, yet their relative impact on patient centered outcomes remains insufficiently explored. This prospective observational study included 68 women aged 65 years and older who underwent abdominal surgery for gynecologic malignancies. Preoperative cognitive function was assessed using the Montreal Cognitive Assessment, and physical frailty was evaluated with the Clinical Frailty Scale. Postoperative outcomes included early recovery parameters, complications, surgical decision satisfaction, and home-based adherence. Higher cognitive scores were associated with earlier mobilization, shorter hospital stay, better postoperative adherence, and greater decision satisfaction, whereas higher frailty scores were associated with delayed recovery and increased complication risk. In regression analyses, preoperative cognitive function was significantly associated with both postoperative adherence and surgical decision satisfaction, whereas physical frailty was not. These findings indicate that preoperative cognitive screening may have predictive value for patient centered recovery behaviors and decision satisfaction in this setting; however, the prediction estimates should be considered exploratory and warrant validation in larger, multicenter cohorts.