Frailty and enhanced recovery after surgery: Who benefits most following colorectal resection?

Background

Frailty and sarcopenia predict postoperative morbidity, but the benefit from enhanced recovery after surgery in high-risk patients is unclear. This study assessed whether frailty is linked to early ambulation and nutrition and whether achievement of these milestones reduces the risk of adverse outcomes among frail older adults.

Methods

In a retrospective cohort study of 5,634 adults aged ≥50 years undergoing inpatient colorectal resection within an integrated health system from 2015 to 2020, frailty was measured using the Hospital Frailty Risk Score; a subset of frail patients was further stratified using computed tomography-derived muscle quantity and quality. Early ambulation and early nutrition were defined as occurring within 12 postoperative hours. The primary outcome was 30-day major morbidity; the secondary outcome was nonhome discharge. Generalized estimating equations were adjusted for demographic and clinical covariates.

Results

Frail patients (Hospital Frailty Risk Score >15) were less likely than nonfrail patients to achieve early ambulation (42% vs 73%) and early nutrition (31% vs 53%). Among frail patients, early ambulation was associated with a greater absolute reduction in 30-day major morbidity (risk difference, -12%; 95% confidence interval, -17% to -7%) than among nonfrail patients (risk difference, -3%; 95% confidence interval, -6% to 0%). Similar patterns were observed for nonhome discharge and for early nutrition. Sarcopenia further identified a high-risk subgroup within frail patients.

Conclusion

Although frail patients are less likely to achieve enhanced recovery after surgery milestones, achievement of these milestones is associated with greater reductions in adverse outcomes. Combined assessment of frailty and sarcopenia may help identify high-risk older adults most likely to benefit from personalized perioperative interventions.