title: The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review.
abstract: Colorectal cancer surgery is frequently performed in the older population. Many older persons have less physiological reserves and are thus more susceptible to adverse postoperative outcomes. Therefore, it seems important to distinguish the fit patients from the more vulnerable or frail. The aim of this review is to examine the evidence regarding the impact of frailty on postoperative outcomes in older patients undergoing surgery for colorectal cancer. A systematic literature search of Medline Ovid was performed focusing on studies that examined the impact of frailty on postoperative outcomes after colorectal surgery in older people aged ≥65years. The methodological quality of the studies was evaluated using the MINORS quality assessment. Five articles, involving four studies and 486 participants in total, were included. Regardless of varying definitions of frailty and postoperative outcomes, the frail patients had less favourable outcomes in all of the studies. Compared to the non-frail group, the frail group had a higher risk of developing moderate to severe postoperative complications, had longer hospital stays, higher readmission rates, and decreased long-term survival rates. The results of this systematic review suggest the importance of assessing frailty in older persons scheduled for colorectal surgery because frailty is associated with a greater risk of postoperative adverse outcomes. We conclude that, although there is no consensus on the definition of frailty, assessing frailty in colorectal oncology seems important to determine operative risks and benefits and to guide perioperative management.
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. Electronic address: katleen.fagard@uzleuven.be.
authors.forename: Katleen
authors.initials: K
authors.lastname: Fagard
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Silke
authors.initials: S
authors.lastname: Leonard
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Deschodt
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Devriendt
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Albert
authors.initials: A
authors.lastname: Wolthuis
authors.affiliation: Department of Gastroenterology, Digestive Oncology Unit, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Prenen
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Flamaing
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
authors.affiliation: Department of Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: Wildiers
authors.affiliation: Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Cindy
authors.initials: C
authors.lastname: Kenis
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality; D016330:Frail Elderly; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors
keywords: Aged; Colorectal neoplasms; Frailty; Geriatric assessment; Postoperative complications; Postoperative outcomes