Key result
Postoperative complications (OR 2.69; 95% CI 1.19-6.09; P=.018) and ostomy creation were independently associated with changing to a frail status 30 days after colorectal cancer surgery.
Why the study?
With a growing colorectal cancer population and need to prevent functional decline, the study aimed to identify factors influencing postoperative frailty using the Kihon Checklist in older patients.
What factors are associated with postoperative change in frailty status in older patients undergoing elective colorectal cancer surgery?
Cohort (n=500)
What factors are associated with postoperative change in frailty status in older patients undergoing elective colorectal cancer surgery?
Odds Ratio: 2.69 (95% CI 1.19–6.09)
p-value: p=.018
Postoperative complications and ostomy creation are independent risk factors for worsening frailty status in older patients undergoing colorectal cancer surgery.
Kihon Checklist may identify frailty linked to complications after colorectal cancer surgery; leaves open whether routine assessment improves outcomes.
Background: The population affected by colorectal cancer is growing, and there is an increasing need for prevention of functional decline following treatment. We proposed that the Kihon Checklist published by the Japanese Ministry of Health, Labor, and Welfare would be an appropriate means of frailty assessment for prediction of postoperative complications in older patients with colorectal cancer. This prospective cohort study aims to identify the factors influencing postoperative frailty. Methods: We prospectively enrolled consecutive patients with colorectal cancer and aged ≥ 65 year (N = 500) between May 2017 and December 2018. Eligible patients were assessed with the Kihon Checklist prior to surgery and 30 days after surgery. The main measures were variables related to postoperative change in view of frail status. Results: According to the Kihon Checklist questionnaire, 164 patients were frail preoperatively and 172 patients were frail postoperatively, whereas 38 patients changed from "nonfrail" before surgery to postoperative "frail." Overall complications were counted in 97 patients (19.4%), and 5 patients died. Performance status ≥ 2, history of laparotomy, open surgery, complication, ostomy creation, and delirium were significantly associated with changing postoperative "frail" (P = .014, P = .023, P = .006, P < .001, P = .023, and P = .024, respectively). In multivariate analysis, independent related factors of changing postoperative "frail" were complication (odds ratio 2.69, 95% confidence interval 1.19-6.09, P = .018) and ostomy creation (odds ratio 2.32, 95% confidence interval 1.01-5.33, P = .047). Conclusion: The Kihon Checklist questionnaire could identify the factors related to postoperative change of frailty status in older patients with colorectal cancer. This cohort concluded that whether postoperative complication occurred or not was closely associated with perioperative change of frailty status.
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Tamura et al. (2022) conducted a cohort in colorectal cancer (n=500). Postoperative complication vs. No postoperative complication was evaluated on changing from nonfrail to frail status postoperatively (OR 2.69, 95% CI 1.19-6.09, p=.018). Postoperative complications (OR 2.69; 95% CI 1.19-6.09; P=.018) and ostomy creation were independently associated with changing to a frail status 30 days after colorectal cancer surgery.
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