Preoperative Frailty as a Predictor of Quality of Life Outcomes Following Cytoreductive Surgery
Zirong Bai, Laura Barker, Rihan Shahab, Cherry Koh, Michael Solomon, Kate Alexander, Sascha Karunaratne, Nabila Ansari, Leani Souza Maximo Pereira, Ana Paula Drummond Lage, Daniel SteffensABSTRACT
Background
Frailty has emerged as a critical determinant of postoperative risk in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). However, its impact on postoperative quality of life (QoL) remains underexplored. Therefore, this study aimed to evaluate the association between preoperative frailty and postoperative QoL in patients undergoing CRS + HIPEC.
Methods
This retrospective cohort study included patients who underwent CRS + HIPEC at the Royal Prince Alfred Hospital between May 2017 and June 2024. Frailty was assessed using the Clinical Frailty Scale (CFS), with patients classified as frail (CFS ≥ 4) or non‐frail (CFS < 4). QoL outcomes were evaluated using the EuroQol 5‐Dimension 5‐Level (EQ‐5D‐5 L) and Short Form‐36 (SF‐36) Health Survey at five time points. Subgroup analyses were conducted based on age (< 65 vs. ≥ 65 years).
Results
Of the 364 included patients, 49 (13.5%) were classified as frail. Frailty was significantly associated with poorer QoL outcomes, particularly in mobility, self‐care, usual activities, and physical component summary (PCS) scores (all p ≤ 0.003) at baseline. These impairments persisted at three and 6 months postoperatively. Pain and discomfort also emerged as significant issues for frail patients at both three‐ and 6‐months following surgery ( p = 0.018 and p = 0.005, respectively). Older frail patients (≥ 65 years) experienced significantly greater impairments in self‐care and usual activities at 6 months postoperatively, along with lower mental health summary (MCS) scores at 12 months compared to the non‐frail group.
Conclusions
Preoperative frailty was significantly associated with poorer QoL outcomes following CRS + HIPEC, highlighting the importance of routine frailty screening and prehabilitation strategies to optimize outcomes in vulnerable patients.