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. 2025 Aug 13.
doi: 10.1007/s11845-025-04060-w. Online ahead of print.

Nutritional status and frailty in elderly patients undergoing major abdominal surgery for upper gastrointestinal tumors: a single-center prospective observational study

Buse Bakir  1 , Habibe Şahin  2 , Gülşah Kaner  3 , Haldun Kar  4 , Osman Nuri Dilek  4
Affiliations

Nutritional status and frailty in elderly patients undergoing major abdominal surgery for upper gastrointestinal tumors: a single-center prospective observational study

Buse Bakir et al. Ir J Med Sci. .

Abstract

Background: Malnutrition and frailty are significant health issues that can result in poor postoperative outcomes for elderly surgical patients.

Aim: This prospective observational study aimed to explore the relationship between frailty, nutritional status, and postoperative outcomes in elderly patients undergoing abdominal surgery for upper gastrointestinal tumors.

Methods: The study included 72 elderly patients (38 frail, 34 pre-frail). All patients were interviewed face-to-face before the surgery, at discharge, and on the 30th day post-discharge. FRAIL was used to determine frailty, and those ≥ 3 were considered 'frail'. Anthropometric measurements and biochemical parameters were recorded during each interview. Additionally, nutritional status was determined by the Mini Nutritional Assessment (MNA), and 3-day food records were also collected.

Results: Frail patients (Median:18 days) experienced longer perioperative hospital stays compared to pre-frail (Median:14 days) (p < 0.001) and had a higher incidence of postoperative complications (p = 0.029). In addition to the MNA score (p < 0.001), mid-upper arm circumference (MUAC) (p < 0.001), calf circumference (CC) (p < 0.001), triceps skinfold thickness (p < 0.05), and handgrip strength (HGS) (p < 0.001) were found to be lower in frail patients at every interview. Albumin, calcium, and magnesium levels were also lower in frail patients (p < 0.001). Additionally, frail patients had significantly lower energy, protein, and calcium intake (p < 0.001), and they were also below the recommended levels. FRAIL score was positively correlated with age, number of comorbidities, medications (p < 0.001), and length of hospitalization (p < 0.05), and negatively correlated with CC, MUAC (p < 0.001), HGS (p < 0.05), MNA, dietary energy, protein, and calcium intake, as well as serum calcium and albumin levels (p < 0.001). MNA score (p = 0.045), serum albumin level (p = 0.022), and dietary energy intake (p < 0.001) were significant determinants of the FRAIL score according to the multiple linear regression.

Conclusions: This study found that frailty is associated with malnutrition and adverse surgical outcomes in elderly patients. The results underline the importance of the assessment of frailty and nutritional status in both pre- and postoperative periods.

Keywords: Elderly; Frailty; Malnutrition; Nutritional status; Surgery.

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Conflict of interest statement

Declarations. Ethics Approval: Izmir Katip Çelebi University’s Non-Interventional Clinical Research Ethical Committee approved the study (Decision Number: 0122), and Izmir Atatürk Training and Research Hospital accepted the study to be conducted in the General Surgery Clinic. After being informed about the study method and process, both verbal and written informed consent were obtained from all patients. The study was completed in adherence with the ethical principles of the Declaration of Helsinki. Conflict of interest: The authors have no financial and/or other conflicts of interest. The research has not been previously published anywhere.

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