Impact of frailty on short-term postoperative outcomes in patients undergoing colorectal cancer surgery: A systematic review and meta-analysis

Abstract

Background: Colorectal cancer is a major global health challenge that predominantly affects older people. Surgical management, despite advancements, requires careful consideration of preoperative patient status for optimal outcomes.

Aim: To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.

Methods: A literature search was conducted using PubMed, EMBASE and Scopus databases for observational studies in adult patients aged ≥ 18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis. Only studies that conducted frailty assessment using recognized frailty assessment tools and had a comparator group, comprising nonfrail patients, were included. Pooled effect sizes were reported as weighted mean difference or relative risk (RR) with 95% confidence intervals (CIs).

Results: A total of 24 studies were included. Compared with nonfrail patients, frailty was associated with an increased risk of mortality at 30 d (RR: 1.99, 95%CI: 1.47-2.69), at 90 d (RR: 4.76, 95%CI: 1.56-14.6) and at 1 year (RR: 5.73, 95%CI: 2.74-12.0) of follow up. Frail patients had an increased risk of any complications (RR: 1.81, 95%CI: 1.57-2.10) as well as major complications (Clavien-Dindo classification grade ≥ III) (RR: 2.87, 95%CI: 1.65-4.99) compared with the control group. The risk of reoperation (RR: 1.18, 95%CI: 1.07-1.31), readmission (RR: 1.70, 95%CI: 1.36-2.12), need for blood transfusion (RR: 1.67, 95%CI: 1.52-1.85), wound complications (RR: 1.49, 95%CI: 1.11-1.99), delirium (RR: 4.60, 95%CI: 2.31-9.16), risk of prolonged hospitalization (RR: 2.09, 95%CI: 1.22-3.60) and discharge to a skilled nursing facility or rehabilitation center (RR: 3.19, 95%CI: 2.0-5.08) was all higher in frail patients.

Conclusion: Frailty in colorectal cancer surgery patients was associated with more complications, longer hospital stays, higher reoperation risk, and increased mortality. Integrating frailty assessment appears crucial for tailored surgical management.

Keywords: Colorectal cancer; Colorectal surgery; Complications; Frail adults; Frailty; Meta-analysis; Mortality; Slinical outcomes; Survival.

Figure 1

Selection process of studies included in the review.

Figure 2

Risk of mortality among frail patients undergoing colorectal cancer surgery, compared with nonfrail patients. RR: Relative risk; CI: Confidence interval.

Figure 3

Risk of any and major complications among frail patients undergoing colorectal cancer surgery, compared with nonfrail patients. RR: Relative risk; CI: Confidence intervals.

Figure 4

Risk of reoperation, readmission and need for blood transfusion among frail patients undergoing colorectal cancer surgery, compared with nonfrail patients. RR: Relative risk; CI: Confidence interval.

Figure 5

Risk of wound complication, delirium, prolonged hospital stay and discharge to skilled nursing facility among frail patients undergoing colorectal cancer surgery, compared with nonfrail patients. RR: Relative risk; CI: Confidence intervals.

Figure 6

Duration of hospital stay (in days) among frail patients, compared with nonfrail patients, undergoing colorectal cancer surgery. WMD: Weighted mean difference; CI: Confidence interval.