What is the clinical evidence from this study?

Study design: Observational. Population: Older adults (≥65 years) undergoing elective oncologic colorectal resection for colorectal cancer (n=200). Intervention: Preoperative Edmonton Frail Scale (EFS) assessment. Primary outcome: 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).

What does this research mean for the field?

The preoperative Edmonton Frail Scale independently predicts 30-day postoperative complications and mortality in patients aged 65 and older undergoing colorectal cancer surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to determine if the Edmonton Frail Scale can independently predict 30-day morbidity and mortality after colorectal cancer surgery in older adults.

March 1, 2026Open Access

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

Key Result

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.

Key Points

This study aims to determine if the Edmonton Frail Scale can independently predict 30-day morbidity and mortality after colorectal cancer surgery in older adults.
Prospective observational design involving patients aged ≥ 65 years
Conducted during elective oncologic colorectal resection
Patients stratified by Edmonton Frail Scale into five categories
Assessment of postoperative complications using Clavien–Dindo classification
Multivariable logistic regression and ROC analysis for associations
30-day postoperative complications occurred in 20% of patients
30-day mortality rate was 5%
EFS showed excellent discrimination for predicting complications, AUC 0.928
EFS was independently associated with complications (OR 1.284, p = 0.006) and mortality (OR 1.323, p = 0.014)

Study Design

Type

Observational (n=200)

Multicenter

Structured PICO

Does the Edmonton Frail Scale (EFS) independently predict 30-day postoperative complications and mortality in older adults undergoing elective colorectal cancer surgery?

Population

200 adults aged ≥ 65 years (median age 70, 63% male) undergoing elective oncologic colorectal resection for colorectal cancer.

Intervention

Preoperative frailty assessment using the Edmonton Frail Scale (EFS), stratifying patients into five categories (non-frail, vulnerable, mildly frail, moderately frail, severely frail).

Comparator

Comparison across the five EFS frailty categories.

Outcome

30-day postoperative complications (medical and surgical, graded by Clavien-Dindo; Grade I-II vs Grade III-V) and 30-day all-cause mortality.hard clinical

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.

Main Result

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

Limitations

Single-center study conducted in Turkey limiting generalizability
Observational design cannot establish causality
Relatively small sample size for mortality outcome (10 deaths)
Did not include granular procedural details such as tumor location or specific surgical techniques
Follow-up limited to 30 days postoperatively, no long-term outcomes assessed

Abstract

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.

Bookmark

View Full Paper