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. 2025 Aug 25:18:2787-2797.
doi: 10.2147/RMHP.S535855. eCollection 2025.

Association of Preoperative Frailty in Older Taiwanese Patients with Colorectal Cancer

Jhih-Sheng Wang  1   2   3 , Cheng-Chou Lai  2   4 , Shu-Huan Huang  2   4 , Chun-Kai Liao  2   4 , Yu-Shin Hung  1   2 , Wen-Chi Chou  1   2
Affiliations

Association of Preoperative Frailty in Older Taiwanese Patients with Colorectal Cancer

Jhih-Sheng Wang et al. Risk Manag Healthc Policy. .

Abstract

Purpose: Colorectal cancer (CRC) affects older adults disproportionately and presents considerable challenges to surgical management owing to age-related physiological vulnerabilities. Frailty, characterized by a reduced physiological reserve, is a recognized predictor of adverse postoperative outcomes. However, data on the impact of preoperative frailty in Taiwanese older adults with CRC are limited.

Patients and methods: A retrospective cohort study was conducted using prospectively collected data from a Taiwanese medical center between 2016 and 2018. A comprehensive geriatric assessment (CGA) encompassing eight domains was performed to preoperatively assess patients aged ≥65 years undergoing curative CRC surgery for frailty. Patients were classified as fit (≤1 deficit) or frail (>1 deficit). Postoperative complications and overall survival (OS) were compared between the groups.

Results: Among 179 patients (median age, 74, range 65‒99), 46.9% were identified as frail. Malnutrition was the most common deficiency (47%). Frail patients had significantly higher rates of intensive care unit admission (13.1% vs 3.2%, p = 0.023), major postoperative complications (50% vs 26.3%, p = 0.001), and longer hospital stay (median 11 vs 9 days, p = 0.002). All three in-hospital deaths occurred in frail patients. Frailty independently predicted worse OS (adjusted hazard ratio 1.88, 95% confidence interval 1.02-3.73, p = 0.040), with a dose-dependent increase in complication risk corresponding to the number of frailty deficits.

Conclusion: Our findings revealed that preoperative frailty is prevalent and independently associated with poor surgical and survival outcomes in older Taiwanese patients with colorectal cancer. Incorporating a CGA-based frailty assessment into preoperative planning may enhance risk stratification and guide tailored perioperative care in this vulnerable population.

Keywords: colorectal cancer; geriatric assessment; postoperative events; survival outcome.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Overall survival according to frailty status.
See this image and copyright information in PMC

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