Effect of Frailty on Postoperative Outcomes Following Major Abdominal Surgeries: A Prospective Observational Study

Abstract

Background: Frailty poses unique challenges for patients undergoing major cancer surgeries due to their extreme vulnerability to physiological stressors and can be an important factor in determining postoperative outcomes. Aims and objective: The objective of the study was to determine the incidence of frailty in patients undergoing major abdominal cancer surgeries and identify the risk factors predicting poor outcomes. Materials and methods: This was a prospective observational study conducted following institutional ethics approval and CTRI registration. We included 308 adult patients who underwent major abdominal cancer surgeries over two years. The preoperative frailty score was calculated using the 11-point modified frailty index score (mFI scale). Patients with a mFI score ≥ 3 points were considered frail. Clinical outcomes such as postoperative complications (Clavien–Dindo grades III and IV), surgical site infections, need for vasopressors, mechanical ventilation, acute kidney injury (AKI), length of ICU and hospital stay, and mortality at 30 days were recorded. Results: The overall incidence of frailty according to the mFI scale was 8.1%. Age and higher American Society of Anesthesiology (ASA) status were significantly associated with frailty (OR –1.073, p < 0.001, and OR –10.220, p < 0.001) respectively. Frailty was an independent predictor of major postoperative complications (OR –8.147, 95%; CI –2.524–26.292, p < 0.001). Frailty was also significantly associated with an increased duration of mechanical ventilation and length of stay (p < 0.001). Conclusion: The modified frailty index (mFI) score remains a strong predictor of postoperative complications in patients undergoing major abdominal cancer surgeries and can help optimize risk factors to minimize complications.