Postoperative frailty among elderly patients undergoing radical surgery for gastrointestinal tumors and its relationship with prognosis

Background: Frailty is a prevalent geriatric syndrome that heightens surgical risk, but its postoperative course and clinical implications in gastrointestinal cancer remain insufficiently defined. This study aims to systematically investigate postoperative frailty (PF) in elderly patients with gastrointestinal cancer. Methods: A total of 398 patients aged ≥60 years who underwent elective radical gastrointestinal tumors resection were enrolled. Frailty was assessed using the Edmonton Frail Scale (EFS) preoperatively and on postoperative day (POD) 5. Clinicopathological factors, postoperative complications, short-term outcomes, and long-term survival were analyzed. Results: PF was observed in 54.0% of patients and was independently associated with advanced age, higher tumor stage, severe comorbidity, open surgery, prolonged operative time, hypoalbuminemia, and preoperative frailty. PF markedly increased complication rates, including intestinal obstruction, pleural effusion, pulmonary infection, and acute kidney injury, and was linked to higher in-hospital mortality, intensive care unit readmission, and 30-day unplanned readmission. The EFS on POD 5 showed good discrimination for complications [area under the curve (AUC) =0.83]. Kaplan-Meier analysis showed significantly reduced 3-year overall and disease-free survival in PF patients. Conclusions: PF is common in elderly patients undergoing radical gastrointestinal tumor surgery and is associated with complications, poor short-term recovery, and impaired long-term survival.