Preoperative Iron Deficiency Anemia and Frailty in Geriatric Colorectal Cancer Surgery: A Prospective Observational...

Objective: Although iron deficiency anemia (IDA) and frailty are common among geriatric surgical patients-frailty has been reported in approximately 31% of patients undergoing colorectal cancer surgery-prospective data on the association between IDA and frailty in patients undergoing surgery for colorectal cancer remain limited. The primary objective of this study was to compare preoperative frailty, assessed using the total Edmonton Frail Scale (EFS) score, a 17-point multidimensional instrument evaluating cognitive, functional, physical, nutritional and psychosocial domains of frailty, between geriatric patients with and without IDA undergoing elective colorectal cancer surgery. Methods: This study included 120 patients aged ≥65 years scheduled for elective laparoscopic colorectal cancer surgery. Preoperative frailty was assessed using the EFS. Anemia was defined as hemoglobin < 13 g/dL; iron metabolism parameters were assessed in anemic patients to determine IDA. The primary outcome was the difference in total EFS scores between patients with and without IDA. Secondary outcomes included early postoperative recovery, postoperative complications, and lengths of intensive care unit (ICU) and hospital stay. Results: Anemia was present in 60 patients (50.0%) and IDA in 41 (34.2%). EFS scores were higher in patients with IDA (6.0 [4.5-10.0] vs. 3.0 [2.0-4.0]; p < 0.001), and this association persisted after adjustment for age and the Charlson Comorbidity Index (p < 0.001). Postoperative complications were more frequent in the IDA group (46.3% vs. 7.6%; p < 0.001). In a three-group comparison, anemic patients without iron deficiency did not differ from non-anemic patients in EFS score, Modified Aldrete Score (a 0-10 scale assessing early postoperative recovery in the post-anesthesia care unit) or ICU length of stay, whereas patients with IDA differed from both groups. The EFS discriminated postoperative complications (AUC = 0.807; 95% CI 0.714-0.900), and EFS ≥ 6.5 was associated with complications in the prespecified model (OR 4.51; 95% CI 1.15-17.66; p = 0.030), although this was attenuated after adjustment for comorbidity burden (OR 4.64; 95% CI 0.96-22.31; p = 0.056). Conclusions: Preoperative IDA was associated with greater frailty in geriatric patients undergoing elective colorectal cancer surgery, and this was not explained by anemia alone, since anemic patients without iron deficiency resembled non-anemic patients. Patients with IDA also had more frequent postoperative complications and poorer early recovery. Frailty was associated with postoperative complications, although this was attenuated after adjustment for comorbidity burden. Combined assessment of anemia etiology and frailty may therefore contribute to preoperative risk stratification.