Can the frailty score independently predict postoperative morbidity in patients with colorectal cancer? A prospective observational study

BACKGROUND: Frailty is associated with adverse surgical outcomes in older adults. We evaluated whether the Edmonton Frail Scale (EFS) is independently associated with 30-day postoperative morbidity and mortality after major colorectal cancer surgery. METHODS: This prospective observational study enrolled patients aged ≥ 65 years undergoing elective oncologic colorectal resection (March–September 2025). Patients were stratified into five EFS frailty categories. The primary outcomes were 30-day postoperative complications (Clavien–Dindo; Grade I–II vs Grade III–V) and 30-day all-cause mortality. Associations were assessed using ROC analysis and multivariable logistic regression. RESULTS: Of 205 enrolled patients, 200 were analyzed (63% male; median age 70 years). Thirty-day postoperative complications occurred in 40 patients (20%), and 30-day mortality was 5% (10/200). EFS was associated with longer hospital length of stay and higher complication and mortality rates. EFS showed excellent discrimination for postoperative complications (AUC 0.928; 95% CI 0.886–0.970), with an optimal cut-off of ~ 6.5 (sensitivity 96.2%, specificity 76.9%). In multivariable models, EFS remained independently associated with complications (OR 1.284; p = 0.006) and mortality (OR 1.323; p = 0.014). CONCLUSIONS: Preoperative EFS provides independent and clinically meaningful prediction of 30-day morbidity and mortality after major colorectal cancer surgery in older adults and may enhance perioperative risk stratification and shared decision-making. TRIAL REGISTRATION: NCT06866678 and registration on 05 March 2025.