Preoperative Iron Deficiency Anemia and Frailty in Geriatric Colorectal Cancer Surgery: A Prospective Observational Study
4 affiliations
- 1Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Sciences, 42020 Konya, Türkiye
- 2Department of Anesthesiology and Reanimation, Faculty of Medicine, Necmettin Erbakan University, 42080 Konya, Türkiye
- 3Department of Anesthesiology and Reanimation, Kastamonu Education and Research Hospital, 37150 Kastamonu, Türkiye
- 4Department of Anesthesiology and Reanimation, Aksaray Education and Research Hospital, 68200 Aksaray, Türkiye
Abstract
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.
Related
- Geriatric Assessment-Based Stratification to Evaluate Treatment Intensity, Quality of Life, and Survival in Older Patients With Metastatic Colorectal Cancer: Protocol for a Prospective Observational Study.
- Comparison of feasibility, inter-instrument agreement, and prognostic value of four frailty assessment instruments in geriatric colorectal cancer patients: a 3-year multicenter prospective cohort study
- Evaluating [¹⁸F]-AlF-FAPI-74 PET/CT for diagnosis of the unfavourable CMS4 colorectal cancer subtype (FoCus study): protocol for a prospective, observational, proof-of-concept clinical study.
- Surgical Impact on Postoperative Morbidity in Colorectal Cancer with Peritoneal Metastasis: A Multicenter Prospective Observational Study.
- Association of preoperative systemic immune-inflammation index and geriatric nutritional risk index with prolonged postoperative length of stay in older patients with hip fracture : A retrospective cohort study
BibTeX
@article{kaya2026preoperative,
title = {{Preoperative Iron Deficiency Anemia and Frailty in Geriatric Colorectal Cancer Surgery: A Prospective Observational Study}},
author = {Asiye Özkan Kaya and Resul Yılmaz and Şule Arıcan and Ayşe Karakol and Havva Nur Günay and Gülçin Büyükbezirci},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197642},
url = {https://europepmc.org/article/PMC/PMC13666234},
note = {CC BY},
}
RIS
TY - JOUR
TI - Preoperative Iron Deficiency Anemia and Frailty in Geriatric Colorectal Cancer Surgery: A Prospective Observational Study
AU - Asiye Özkan Kaya
AU - Resul Yılmaz
AU - Şule Arıcan
AU - Ayşe Karakol
AU - Havva Nur Günay
AU - Gülçin Büyükbezirci
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197642
UR - https://europepmc.org/article/PMC/PMC13666234
AB - 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.
SN - 2077-0383
ER -