Preoperative Frailty as a Predictor of Quality of Life Outcomes Following Cytoreductive Surgery

BACKGROUND: Frailty has emerged as a critical determinant of postoperative risk in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). However, its impact on postoperative quality of life (QoL) remains underexplored. Therefore, this study aimed to evaluate the association between preoperative frailty and postoperative QoL in patients undergoing CRS + HIPEC. METHODS: This retrospective cohort study included patients who underwent CRS + HIPEC at the Royal Prince Alfred Hospital between May 2017 and June 2024. Frailty was assessed using the Clinical Frailty Scale (CFS), with patients classified as frail (CFS ≥ 4) or non-frail (CFS < 4). QoL outcomes were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5 L) and Short Form-36 (SF-36) Health Survey at five time points. Subgroup analyses were conducted based on age (< 65 vs. ≥ 65 years). RESULTS: Of the 364 included patients, 49 (13.5%) were classified as frail. Frailty was significantly associated with poorer QoL outcomes, particularly in mobility, self-care, usual activities, and physical component summary (PCS) scores (all p ≤ 0.003) at baseline. These impairments persisted at three and 6 months postoperatively. Pain and discomfort also emerged as significant issues for frail patients at both three- and 6-months following surgery (p = 0.018 and p = 0.005, respectively). Older frail patients (≥ 65 years) experienced significantly greater impairments in self-care and usual activities at 6 months postoperatively, along with lower mental health summary (MCS) scores at 12 months compared to the non-frail group. CONCLUSIONS: Preoperative frailty was significantly associated with poorer QoL outcomes following CRS + HIPEC, highlighting the importance of routine frailty screening and prehabilitation strategies to optimize outcomes in vulnerable patients.