Physiological reserve and early recovery across oncologic and non-oncologic abdominal surgery: a prospective multicenter interaction analysis
11 affiliations
- 1Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center
- 2Department of Surgery, San Camillo Hospital
- 3General and Specialistic Surgery Department, Emergency General Surgery Unit, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino
- 4Department of Medicine, Academy of Applied Medical and Social Sciences-Akademia Medycznych I Spolecznych Nauk Stosowanych (AMiSNS)
- 5Department for Geriatric Medicine, Clinic Barmelweid AG
- 6Department of General and Thoracic Surgery, SS. Annunziata University Hospital
- 7Department of Medical, Oral, and Biotechnological Sciences, G. d’Annunzio University of Chieti
- 8Bakhutashvili Institute of Medical Biotechnology, Tbilisi State Medical University
- 9Department of General Surgery, Anesthesia and Urology, Faculty of Medicine, The Hashemite University
- 10Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia
- 11Department of Surgery, Dnipro State Medical University
Abstract
Background: Frailty and low handgrip strength are established markers of limited physiological reserve, but it is uncertain whether their prognostic meaning differs between oncologic and non-oncologic surgery. We examined whether oncologic indication modifies the associations of preoperative frailty and baseline handgrip strength with early postoperative outcomes.
Methods: This secondary analysis used a prospective cohort conducted at participating surgical centers between January 2023 and June 2025. Frailty was classified using the Fried phenotype, and handgrip strength was measured at admission. The primary outcome was prolonged length of stay (LOS >10 days); secondary outcomes were any postoperative complication, major complications, and log-transformed LOS. Effect modification was evaluated using interaction terms in multivariable logistic models adjusted for age and sex. Because no prolonged stays occurred among fit patients in the non-oncologic stratum, categorical frailty models used Firth penalized logistic regression.
Results: Among 222 clinically characterized participants, 118 (53.2%) underwent oncologic surgery. Prolonged LOS occurred in 41/118 (34.7%) oncologic and 7/104 (6.7%) non-oncologic patients. The complete-case primary analysis included 216 patients and 45 events. In an additional ordinal main-effects model, increasing frailty [odds ratio (OR) 2.91 per category, 95% confidence interval (CI) 1.57–5.38], lower handgrip strength (OR 0.95 per kg, 95% CI 0.90–0.99), and oncologic indication (OR 8.97, 95% CI 3.47–23.19) were associated with prolonged LOS. However, categorical frailty-by-oncology interaction was not supported (global p = 0.341), nor was handgrip-strength-by-oncology interaction ( p = 0.739); the joint interaction test was not statistically significant ( p = 0.525). No convincing effect modification was observed for complications or continuous LOS.
Conclusions: Oncologic surgery was associated with a substantially higher early postoperative burden, while frailty and handgrip strength retained prognostic relevance. No clear evidence of multiplicative interaction by oncologic indication was detected, but clinically meaningful effect modification cannot be excluded. Physiological reserve assessment should therefore be considered across elective abdominal surgery rather than restricted to the oncologic setting.
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BibTeX
@article{girnyi2026physiological,
title = {{Physiological reserve and early recovery across oncologic and non-oncologic abdominal surgery: a prospective multicenter interaction analysis}},
author = {Sergii Girnyi and Francesco Giovinazzo and Elena Montanari and Eugenia Semeraro and Alessandra Marano and Jaroslaw Skokowski and Tomasz Cwalinski and Mathias Schlögl and Mirko Barone and Archil Aladashvili and Mahmoud Al-Balas and Virginia Boccardi and Mauro Santarelli and Luigi Marano},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1954486},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1954486/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Physiological reserve and early recovery across oncologic and non-oncologic abdominal surgery: a prospective multicenter interaction analysis
AU - Sergii Girnyi
AU - Francesco Giovinazzo
AU - Elena Montanari
AU - Eugenia Semeraro
AU - Alessandra Marano
AU - Jaroslaw Skokowski
AU - Tomasz Cwalinski
AU - Mathias Schlögl
AU - Mirko Barone
AU - Archil Aladashvili
AU - Mahmoud Al-Balas
AU - Virginia Boccardi
AU - Mauro Santarelli
AU - Luigi Marano
PY - 2026
DA - 2026/10/15
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1954486
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1954486/full
AB - Background: Frailty and low handgrip strength are established markers of limited physiological reserve, but it is uncertain whether their prognostic meaning differs between oncologic and non-oncologic surgery. We examined whether oncologic indication modifies the associations of preoperative frailty and baseline handgrip strength with early postoperative outcomes. Methods: This secondary analysis used a prospective cohort conducted at participating surgical centers between January 2023 and June 2025. Frailty was classified using the Fried phenotype, and handgrip strength was measured at admission. The primary outcome was prolonged length of stay (LOS >10 days); secondary outcomes were any postoperative complication, major complications, and log-transformed LOS. Effect modification was evaluated using interaction terms in multivariable logistic models adjusted for age and sex. Because no prolonged stays occurred among fit patients in the non-oncologic stratum, categorical frailty models used Firth penalized logistic regression. Results: Among 222 clinically characterized participants, 118 (53.2%) underwent oncologic surgery. Prolonged LOS occurred in 41/118 (34.7%) oncologic and 7/104 (6.7%) non-oncologic patients. The complete-case primary analysis included 216 patients and 45 events. In an additional ordinal main-effects model, increasing frailty [odds ratio (OR) 2.91 per category, 95% confidence interval (CI) 1.57–5.38], lower handgrip strength (OR 0.95 per kg, 95% CI 0.90–0.99), and oncologic indication (OR 8.97, 95% CI 3.47–23.19) were associated with prolonged LOS. However, categorical frailty-by-oncology interaction was not supported (global p = 0.341), nor was handgrip-strength-by-oncology interaction ( p = 0.739); the joint interaction test was not statistically significant ( p = 0.525). No convincing effect modification was observed for complications or continuous LOS. Conclusions: Oncologic surgery was associated with a substantially higher early postoperative burden, while frailty and handgrip strength retained prognostic relevance. No clear evidence of multiplicative interaction by oncologic indication was detected, but clinically meaningful effect modification cannot be excluded. Physiological reserve assessment should therefore be considered across elective abdominal surgery rather than restricted to the oncologic setting.
SN - 2234-943X
ER -