Preoperative risk assessment using GNRI and mFI-5 enhances prediction of postoperative complications in older adults with colorectal cancer.

PURPOSE: Frailty and malnutrition, which are common in older adult patients with colorectal cancer (CRC), adversely affect outcomes. Although the Geriatric Nutritional Risk Index (GNRI) and the Modified Frailty Index (mFI-5) are established tools, their combined predictive value for postoperative complications remains unclear. Therefore, we investigated whether their combination improved risk prediction.

METHODS

We analyzed 399 CRC ≥ 65 years of age who underwent curative surgery. Preoperative assessment included frailty (mFI-5 ≥ 2) and nutritional risk (GNRI < 98). Patients were stratified into low- (no factors), intermediate- (one factor), and high-risk (both factors) groups. Clavien-Dindo grade ≥ II complications were analyzed by multivariate logistic regression to identify predictive factors.

RESULTS

Infectious complications increased significantly across the low-, intermediate-, and high-risk groups (13.3%, 14.6%, and 30.2%, respectively), with overall complication rates of 20.7%, 22.2%, and 45.3%, respectively. The median postoperative stay increased with increased risk (12, 14, and 18 days, respectively). Anastomotic leakage was more frequent, though not to a statistically significant extent, in high-risk patients. High-risk status independently predicted infectious and overall complications.

CONCLUSIONS

Combined GNRI and mFI-5 assessments facilitated effective stratification of postoperative risk in older adults with CRC. These assessments may help in routine preoperative evaluations and support individualized perioperative care.