Key result
Higher Edmonton Frail Scale predicts ~28% greater 30-day complication risk per point after colorectal cancer surgery.
Why the study?
Frailty is associated with adverse surgical outcomes in older adults, but whether the Edmonton Frail Scale independently predicts 30-day postoperative morbidity and mortality after major colorectal cancer surgery needed evaluation.
Does the Edmonton Frail Scale (EFS) independently predict 30-day postoperative complications and mortality in older adults undergoing elective colorectal cancer surgery?
Observational (n=200)
No
Does the Edmonton Frail Scale (EFS) independently predict 30-day postoperative complications and mortality in older adults undergoing elective colorectal cancer surgery?
Effect estimate: OR 1.284 for postoperative complications per 1-point increase in EFS; OR 1.323 for mortality per 1-point increase in EFS (95% CI Complications 95% CI 1.075-1.535; Mortality 95% CI 1.060-1.652)
p-value: p=0.006 for complications; 0.014 for mortality
Preoperative frailty assessment using the Edmonton Frail Scale provides excellent discrimination for predicting 30-day postoperative complications and mortality in older adults undergoing colorectal cancer surgery.
Supports preoperative EFS screening in patients ≥65 undergoing colorectal cancer surgery; extends evidence to elective oncologic procedures in older adults.
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. 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. 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). 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. NCT06866678 and registration on 05 March 2025.
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Sahin et al. (2026) conducted an observational in Older adults (≥65 years) undergoing elective oncologic colorectal resection for colorectal cancer (n=200). Preoperative Edmonton Frail Scale (EFS) assessment was evaluated on 30-day postoperative complications (medical and surgical, Clavien-Dindo Grade I-V) and 30-day all-cause mortality (OR 1.284 for postoperative complications per 1-point increase in EFS; OR 1.323 for mortality per 1-point increase in EFS, 95% CI Complications 95% CI 1.075-1.535; Mortality 95% CI 1.060-1.652, p=0.006 for complications; 0.014 for mortality). Preoperative Edmonton Frail Scale independently predicted 30-day postoperative complications (OR 1.284, p=0.006) and mortality (OR 1.323, p=0.014) in patients ≥65 undergoing colorectal cancer surgery.
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