Impact of pre-operative frailty on hospital length of stay in major abdominal oncological surgeries: A prospective, observational study

Background and Aims: Frailty increases vulnerability to stressors, negatively impacting cancer outcomes. We evaluated the association between pre-operative frailty and post-operative outcomes in Indian patients undergoing major abdominal cancer surgery and explored ultrasound-based sarcopenia markers for frailty screening. Methods: Frailty was assessed using the Fried Frailty Phenotype. The primary outcome was hospital length of stay (LOS); secondary outcomes included severe complications (Clavien–Dindo III/IV), intensive care unit stay, and 30- and 90-day mortality. Pre-operative ultrasound-guided quadriceps thickness and rectus femoris cross-sectional area (CSA) were measured, and their cut-off values were derived via receiver operating characteristic (ROC) curves as screening parameters for pre-operative frailty. Results: Among 142 patients, 68 (47.8%) were frail. Frail patients had longer hospital stays {median 9 vs. 6 days; relative risk (RR) 1.20 [95% confidence interval (CI) 1.02 to 1.41]}; P = 0.031. On multivariate analysis, frailty {RR 1.16 [95% CI 1.03 to 1.31]}; P = 0.012 and American Society of Anesthesiologists physical status (ASA-PS) > III {RR 1.35 [95% CI 1.10 to 1.65]}; P = 0.004 independently predicted prolonged LOS. ROC analysis showed poor predictive ability of ultrasonography: {area under curve 0.591 [95% CI 0.497 to 0.685]}; P = 0.061 for body mass index-normalised quadriceps thickness; {0.613 [95% CI 0.519 to 0.707]}; P = 0.020 for rectus femoris CSA, which improved to {0.721 [95% CI 0.636 to 0.806]} with pre-operative anaemia. The diagnostic accuracy was 65.5% and 64.3%, respectively; the sensitivity/specificity for quadriceps was 78%/54%, and for rectus femoris, CSA was 50%/78%. DeLong’s test showed no significant difference ( P = 0.6). Conclusion: Frailty prolongs hospital stay but not complications or mortality. Ultrasound alone poorly predicts frailty. Combining pre-operative anaemia improves the predictive value of rectus femoris ultrasound assessment.