Higher hospital frailty risk score is predictive of 90-day readmission after minimally invasive colorectal cancer surgery: a national readmission database analysis

Abstract

Minimally invasive procedures are common in colorectal cancer (CRC) surgeries, but the impact of frailty on postoperative outcomes is unclear. This study aimed to assess how frailty status affects postoperative outcomes after minimally invasive CRC surgery. This study examined the impact of frailty on postoperative outcomes following minimally invasive colorectal cancer (CRC) surgery. Using data from the 2016-2020 U.S. National Readmission Database, the study included patients aged ≥ 60 years who underwent first-time minimally invasive (laparoscopic or robotic) CRC resection during hospitalization. Patients were categorized into low, intermediate, and high frailty risk groups based on the Hospital Frailty Risk Score (HFRS). Outcomes assessed included 90-day readmissions, in-hospital mortality, and complications. The analysis of 6,417 patients revealed that intermediate frailty was associated with higher in-hospital mortality (OR = 2.01), and high frailty had an even greater risk (OR = 3.83). Frailty also showed a dose-response relationship with complications, with the odds of complications being significantly higher in both intermediate (OR = 4.59) and high frailty groups (OR = 37.12). Only the high frailty group had an elevated risk of 90-day readmission (OR = 1.27). Certain subgroups, such as patients aged < 80, without diabetes or chronic kidney disease, with rectal tumors, and those undergoing robotic surgery, were particularly affected by frailty in terms of in-hospital mortality. The study highlights that higher frailty, as measured by the HFRS, is a strong predictor of adverse postoperative outcomes and early readmission in older patients undergoing minimally invasive CRC surgery, with especially notable effects in certain subgroups, possibly due to the greater surgical complexity or physiological burden in these groups.