Aug 2026· Clinical Interventions in Aging· Vol 21· 0 citations· 30 references
Medicine
TL;DR
Combining frailty with an objective inflammation–nutrition risk composite modestly improved internal model performance for 30-day severe complications and 90-day readmission in older EC patients, and 1-year non-EC death analysis remains exploratory.
Abstract
Background Frailty and systemic inflammation/immune–protein reserve may drive adverse outcomes after endometrial cancer (EC) surgery in older patients, but their incremental predictive value is unclear. Methods We analyzed a retrospective cohort of women ≥65 years undergoing primary EC surgery between January 2016 and December 2024. Frailty was assessed using mFI‑5. Inflammation–nutrition status (INS) was derived from routine preoperative laboratory tests as exploratory composite. The primary endpoint was 30‑day severe complications (Clavien–Dindo III–V), and the secondary endpoint was 90‑day unplanned readmission to the index hospital. One‑year non–endometrial cancer (non‑EC) death was exploratory with EC death as a competing event. Logistic regression and Fine–Gray models were fitted. Incremental prediction versus a prespecified baseline perioperative clinical model was evaluated with bootstrap optimism‑corrected discrimination, calibration, and decision‑curve analysis. Results Severe complications occurred in 62 (7.1%) and readmission in 71 (8.1%). One‑year non‑EC and EC deaths were 28 (3.2%) and 19 (2.2%), respectively. mFI‑5 and INS predicted severe complications (OR per 1‑point mFI‑5 1.43 [95% CI 1.22–1.67]; OR per 1‑SD INS 1.34 [1.15–1.55]) and readmission (OR 1.28 [1.10–1.50]; OR 1.22 [1.05–1.41]). For non‑EC death, mFI‑5 (SHR 1.52 [1.23–1.88]) and INS (SHR 1.37 [1.11–1.69]) were significant. Adding mFI‑5+INS improved discrimination (AUC 0.69 to 0.77 for complications; 0.63 to 0.70 for readmission) and the time-dependent C-index for the exploratory competing-risk endpoint (0.66 to 0.73), with acceptable calibration. Decision-curve findings were descriptive rather than definitive. Conclusion Combining frailty with an objective inflammation–nutrition risk composite modestly improved internal model performance for 30-day severe complications and 90-day readmission in older EC patients, and 1-year non-EC death analysis remains exploratory. These findings should be interpreted as perioperative rather than purely preoperative prediction, and decision thresholds require external validation before protocolized use.
Integrating serum albumin, hematocrit, BMI, spinal region, and procedure type with frailty indices enhances risk stratification and informs surgical planning, preoperative optimization, and patient counseling in this vulnerable population of patients.
A. Ghaith, Xinlan Yang, Yazan Alasadi et al.· European spine journal· 0 citations
Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated the association between mFI-5-defined frailty and postoperative complications, especially postoperative delirium, as well as survival outcomes in patients undergoing surgery for OSCC. Methods: We retrospectively analyzed 127 patients who underwent surgical resection for OSCC with postoperative high care unit (HCU) management between 2013 and 2021. Frailty was defined as an mFI-5 score of ≥2. Clinical characteristics, postoperative outcomes, HCU stay, length of hospital stay, overall survival (OS), and disease-free survival (DFS) were compared between frail and non-frail groups. Univariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications. An exploratory multivariable logistic regression analysis for postoperative delirium was performed using age ≥65 years and sex as covariates. Delirium was retrospectively assessed from clinical documentation considered consistent with DSM-5 criteria. Results: Twenty-one patients (16.5%) were classified as frail. Postoperative delirium occurred more frequently in frail patients than in non-frail patients (42.9% vs. 19.8%; p = 0.023). In a multivariable logistic regression model adjusted for age ≥65 years and sex, mFI-5-defined frailty was significantly associated with postoperative delirium (adjusted OR, 3.07; 95% CI, 1.08–8.60; p = 0.035). No significant association was observed for pneumonia, surgical site infection, or free-flap reoperation. Frailty was not significantly associated with HCU stay, length of hospital stay, OS, or DFS. Conclusions: mFI-5-defined frailty was associated with postoperative delirium but not with survival outcomes in this OSCC cohort. Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor. Comprehensive perioperative assessment incorporating frailty, nutrition, sarcopenia, cognition, tumor burden, and treatment-related factors may better identify patients at risk.
K. Yamagata, S. Fukuzawa, Shohei Takaoka et al.· Diagnostics· 0 citations
Frailty in surgical patients is difficult to objectively quantify without bias. The FI-Lab is a laboratory-based frailty index derived from routine blood tests and physiological numerical variables only. Validated in medical cohorts, its role in predicting postoperative outcomes following colorectal cancer resection has not been well explored.
This retrospective cohort study included octogenarian patients undergoing colorectal cancer resection at a tertiary centre between 2011 and 2017. FI-Lab scores were calculated by summing variable-specific deficits and dividing by the total number of variables, generating a score from 0 to 1, with higher values indicating greater frailty. Patients were stratified into Low (≤0.20), Moderate (0.21–0.40), and High (>0.40) frailty groups. Postoperative mortality at 1, 2, and 5 years was analysed using univariable comparisons and logistic regression.
A total of 337 patients were included. The overall mean FI-Lab score was 0.241 (range 0.00–0.70). Patients who died within 1 year had significantly higher average FI-Lab scores than survivors (0.319 vs 0.233, p=0.007), with similar associations at 2 years (p=0.020) but not at 5 years. Mortality increased stepwise across frailty groups at 1 year (5.2%, 8.1%, 21.3%; p=0.003) and 5 years (34.2%, 31.1%, 51.1%; p=0.044). On logistic regression, High frailty was significantly associated with greater odds of 1-year (OR 4.62) 2-year (OR 2.34), and 5-year mortality (OR 2.08) compared to Low frailty (p<0.05).
The use of FI-lab in objectively quantifying frailty could be extended to peri-operative risk stratification for elderly colorectal cancer resection patients.
Kaso Ari, A. Abdelaal, Jenny Little et al.· British Journal of Surgery· 0 citations
ABSTRACT Background Frailty predicts outcomes after colorectal cancer surgery, but postoperative changes remain unclear. We previously reported improvement in FRAIL Scale‐based frail/pre‐frail status 1 year after curative minimally invasive surgery (MIS). This study examined the components underlying that improvement using the FRAIL Scale and Kihon Checklist (KCL). Methods This secondary analysis included patients aged ≥ 70 years who underwent curative MIS for colorectal cancer and had preoperative and 1‐year postoperative frailty assessments. Changes in FRAIL Scale and KCL indicators were evaluated using paired analyses. Results Among 239 patients assessed preoperatively, 141 were included in the paired analysis. Among FRAIL Scale items, only the weight‐loss criterion improved significantly (35.8% to 9.5%, p < 0.001). In the KCL, oral function risk improved, whereas physical function risk tended to worsen; houseboundness, cognitive decline, and depressive mood were unchanged. Patients whose FRAIL Scale weight‐loss criterion resolved showed a modest 1.2‐kg increase (p = 0.038), whereas mean body weight remained unchanged overall. In sensitivity analyses, the improvement in oral function risk persisted after excluding patients with preoperative bowel obstruction (p = 0.014). After excluding patients receiving oxaliplatin‐containing adjuvant chemotherapy, physical function risk still tended to increase, and fear of falling remained significantly increased (p = 0.011). Conclusions FRAIL Scale improvement was driven mainly by resolution of the weight‐loss criterion, with modest weight gain and no clear overall body‐weight recovery. KCL changes varied across domains and items, with improvement in some aspects but persistence or worsening in others, supporting a multidimensional interpretation of postoperative recovery in older patients.
H. Ushigome, Takuya Suzuki, S. Hayakawa et al.· Annals of Gastroenterologica...· 0 citations
Background Postoperative complications afflict approximately 40% of patients undergoing colorectal cancer (CRC) surgery and adversely affect long-term oncological outcomes. Reliable perioperative risk stratification tools that are both clinically interpretable and actionable remain limited. Methods This retrospective cohort study enrolled 1,013 consecutive patients undergoing elective radical resection for histopathologically confirmed CRC at a single tertiary center. A nine-system composite complication endpoint was defined. Missing data were handled via multiple imputation by chained equations (MICE; m = 5). Candidate predictors were screened by univariable logistic regression and LASSO regularization; final predictors were entered into multivariable logistic regression with Rubin’s rules pooling. Model performance was assessed by AUC, bootstrap internal validation (1,000 iterations), Hosmer–Lemeshow calibration, and decision curve analysis (DCA). A nomogram was constructed for individualized risk estimation. Results Of 1,013 patients, 372 (36.7%) experienced ≥1 postoperative complication. LASSO selected eight independent predictors: NRS-2002 nutritional risk score (aOR 1.502, 95% CI 1.312–1.720), laparoscopic approach (aOR 0.457, 95% CI 0.297–0.702), intraoperative blood loss (aOR 1.002/mL), right colon tumor location (aOR 1.502), NLR (aOR 1.080/unit), operative time (aOR 1.002/min), hemoglobin, and total bilirubin. The model achieved an apparent AUC of 0.689 (bootstrap-corrected 0.680), satisfactory calibration (Hosmer–Lemeshow p = 0.709), and net clinical benefit across threshold probabilities of 10–90% on DCA. Sensitivity analyses confirmed robustness across four pre-specified scenarios (AUC range 0.666–0.715). Conclusion This LASSO-derived nomogram provides transparent, bedside-applicable risk stratification for postoperative composite complications in CRC surgery, identifying nutritional status as the dominant modifiable predictor and supporting targeted perioperative optimization.
Lu Wang, Shunshun Wang, Liqin Deng· Frontiers in Nutrition· 0 citations
OBJECTIVE
Frailty is a recognized risk factor for poor surgical outcomes, particularly in the elderly. This study evaluates the predictive value of the 5-item Modified Frailty Index in patients aged 70 and older undergoing head and neck cancer resection with microvascular free flap reconstruction.
STUDY DESIGN
Retrospective cohort study.
SETTING
Tertiary academic medical center.
METHODS
Patients aged ≥ 70 years old who underwent oncologic resection and free flap reconstruction from 2014 to 2022 were included. Patients were stratified by 5-item Modified Frailty Index score into non-frail (0), mildly frail (1), and moderately to severely frail (≥2). Primary outcomes included 90-day mortality, 30-day complications, readmission, and return to the operating room. Multivariable logistic regression was used to control potential confounders.
RESULTS
A total of 211 patients were included. Patients with 5-item Modified Frailty Index scores ≥ 2 had significantly higher 90-day mortality compared to less frail patients (p = 0.031), and they were more frequently discharged to a facility rather than home. While not statistically significant, complication and readmission rates were higher in frail patients. Multivariable analysis showed that patients with 5-item Modified Frailty Index ≥ 2 had increased odds of experiencing complications (OR 2.44, 95 % CI 1.06-5.91)and mortality (OR 1.17, 95 % CI 0.36-4.59).
CONCLUSION
The 5-item Modified Frailty Index is a simple and clinically useful tool for identifying older head and neck cancer patients at increased risk of adverse outcomes following major surgery. Its incorporation into preoperative risk assessment may improve surgical decision-making and perioperative planning by better stratifying risk and guiding resource allocation.
John J Sykes, Edgar D Uribe Sanchez, D. Benito et al.· Oral Oncology· 1 citation