Frailty Confers Worse Recovery Outcomes After Gynecologic Surgery

"Frailty evaluation, especially functional status, should be incorporated into preoperative planning and patient counseling," according to the study authors.

Patients undergoing major gynecologic oncology surgery categorized as elderly—those older than 65 years of age—or frail experienced worse postoperative outcomes despite following enhanced recovery after surgery (ERAS) protocols, according to findings from a retrospective analysis presented in a poster at the 2025 Society of Gynecologic Oncology (SGO) Winter Meeting.

Data from the study revealed that elderly patients, accounting for 23% of the population, had a significant association with higher modified frailty index (mFI) scores compared with those classified as non-elderly (P <.001). Patients classified as elderly were more like to be identified as mFI 4 (1.20% vs 0.12%), mFI 3 (6.00% vs 1.83%), mFI 2 (34.80% vs 15.40%), or mFI 1 (41.60% vs 29.30%) vs nonelderly patients.

Additionally, elderly patients were more likely to experience longer length of stays (LOS). Incidence ratio rates (IRR) for LOS in elderly and nonelderly patients, respectively, were 0.924 (95% CI, 0.64-1.34; P = .68) vs 1.04 (95% CI, 0.88-1.23; P = .632) in those with mFI 1, 1.45 (95% CI, 1.01-2.11) vs 1.37 (95% CI, 1.12-1.67) in those with mFI 2, 2.40 (95% CI, 1.37-4.18) vs 1.17 (95% CI, 0.69-1.98; P = .561) in those with mFI 3, and 3.91 (95% CI, 1.39-11.01) vs 0.78 (95% CI, 0.09-6.79; P = .822) in those with mFI 4.

Furthermore, across all age groups, higher mFI scores were associated with higher non-home discharge rates. Odds ratios (OR) for non-home discharge in all patients were 1.97 (95% CI, 0.62-6.26; P = .25) in mFI 1 vs mFI 0, 5.16 (95% CI, 1.78-15.1) in mFI 2 vs mFI 0, 6.78 (95% CI, 1.26-36.5) in mFI 3 vs mFI 0, and 31.6 (95% CI, 2.79-358) in mFI 4 vs mFI 0.

“Despite ERAS protocols, the elderly and frail undergoing major gynecologic oncology surgery have worse postoperative outcomes in terms of LOS and non-home discharge,” Bailey Widstrom, DO, from the Department of Obstetrics, Gynecology and Reproductive Services at the University of Texas Health Science Center at Houston, McGovern Medical School, wrote in the poster with study coinvestigators. “Elderly patients are more likely to have a higher frailty index, making them even more vulnerable postoperatively. Frailty evaluation, especially functional status, should be incorporated into preoperative planning and patient counseling.”

The institutional review board–approved retrospective study assessed 1070 patients with gynecologic cancer who underwent major gynecologic surgery from January 2019 to December 2023. Patients were assigned to the ERAS protocol for gynecologic oncology and were assigned an mFI-5 score based on 5 factors, functional status, diabetes, history of chronic obstructive pulmonary disease (COPD), history of congestive heart failure (CFS), and hypertension.

Patients in the total study cohort and elderly patients had a median age of 53 years (range, 10-91) vs 70 years (range, 66-91). Most patients were either White (46.6% vs 49.2%) or Black (24.7% vs 25.2%), most were not Hispanic (89.8% vs 90.8%), and 9.2% vs 4.8% were smoking at baseline. Patients in the respective groups primarily had an American Society of Anesthesiologists (ASA) classification of III (65.4% vs 77.6%) or II (27.4% vs 12.8%), had malignant disease (52.9% vs 78.4%), and underwent either robotic (52.1% vs 58.0%) or open (42.1% vs 34.8%) operative approaches.

The study end points included LOS, incidence of emergency room visits, hospital readmissions, non-home discharges, and severity of postoperative complications.

Perioperative morbidity in elderly patients and non-elderly patients, respectively, included 5.2% vs 1.6% undergoing non-home discharge (P = .001), 8.4% vs 11.6% undergoing emergency department visits (P = .156), and 7.6% vs 7.9% undergoing readmission (P = .866). Additionally, the Clavien-Dindo surgical complication grade rates in each group included 10.8% vs 8.2% with grade 1 complications, 16.9% vs 15.8% with grade 2 complications, 4.4% vs 3.9% with grade 3 complications, 3.6% vs 3.7% with grade 4 complications, and 0.8% vs 0.6% with grade 5 complications (P = .947).

Reference

Widstrom B, Schulz M, Cervantes J, et al. The impact of frailty on surgical outcomes in gynecologic oncology surgery with ERAS protocols. Presented at the 2025 Society of Gynecologic Oncology Winter Meeting; January 30 – February 1, 2025; Whistler, British Columbia, Canada.