Chronological age and failure to rescue after colorectal cancer surgery: A multicentre cohort study

Background Whether advancing chronological age is associated more strongly with serious postoperative events or with survival after an event remains uncertain. Aims To compare the association of chronological age with major postoperative events and failure to rescue after colorectal cancer surgery. Methods We analyzed 1,124 adults treated at five Polish centers between January 2022 and August 2025. Major events were Clavien–Dindo ≥grade IIIa; failure to rescue was cumulative 90-day death after such an event. Chronological age was analysed per 10-year increase. Multivariable logistic regression examined major events and Firth regression examined failure to rescue. Results Major events occurred in 145 patients; failure to rescue was evaluable in 134 and occurred in 24. Chronological age was not associated with major events (adjusted odds ratio per decade 1.09, 95% confidence interval 0.89–1.33) or nonfatal major morbidity. Failure-to-rescue odds increased per decade (odds ratio 2.02, 95% confidence interval 1.21–3.63); model-standardized probabilities were 11.1% at age 65 and 32.5% at age 85 years. Sensitivity analyses were directionally consistent, but the interval included no association when every model-eligible missing post-event outcome was assigned to death. Discussion The chronological-age gradient was concentrated in survival after a serious event. Frailty and physiological reserve were not measured; reduced reserve remains a plausible explanation rather than a demonstrated mechanism. Conclusions Chronological age may help identify patients who warrant intensified postoperative surveillance and early escalation, while formal geriatric and frailty assessment remains necessary to characterize biological vulnerability.