A new study presented at the 2025 Society of Gynecologic Oncology (SGO) Winter Meeting has revealed that elderly and frail patients face significantly greater challenges in recovery following major gynecologic oncology surgery, even when following enhanced recovery after surgery (ERAS) protocols.
The retrospective analysis, conducted at the University of Texas Health Science Center at Houston, examined 1,070 patients who underwent major gynecologic surgery between January 2019 and December 2023. The findings highlight the substantial impact of age and frailty on post-surgical outcomes.
Age and Frailty Impact on Recovery
Elderly patients, defined as those over 65 years old, represented 23% of the study population and demonstrated significantly higher modified frailty index (mFI) scores compared to younger patients (P <.001). The data revealed a striking correlation between age and frailty, with elderly patients more frequently categorized in higher mFI categories:
- mFI 4: 1.20% vs 0.12% in non-elderly
- mFI 3: 6.00% vs 1.83%
- mFI 2: 34.80% vs 15.40%
- mFI 1: 41.60% vs 29.30%
Length of Stay and Discharge Outcomes
The study found that higher frailty scores significantly impacted hospital length of stay (LOS). Elderly patients with the highest frailty scores (mFI 4) experienced nearly four times longer hospital stays compared to their baseline counterparts (IRR 3.91, 95% CI, 1.39-11.01).
Non-home discharge rates also increased dramatically with higher frailty scores across all age groups:
- mFI 2 vs mFI 0: OR 5.16 (95% CI, 1.78-15.1)
- mFI 3 vs mFI 0: OR 6.78 (95% CI, 1.26-36.5)
- mFI 4 vs mFI 0: OR 31.6 (95% CI, 2.79-358)
Patient Demographics and Surgical Approaches
The study population reflected diverse demographics, with White (46.6%) and Black (24.7%) patients comprising the majority. Most patients were classified as ASA III (65.4%) and underwent either robotic (52.1%) or open (42.1%) surgical procedures.
Clinical Implications
"Despite ERAS protocols, the elderly and frail undergoing major gynecologic oncology surgery have worse postoperative outcomes in terms of LOS and non-home discharge," explains Dr. Bailey Widstrom from the Department of Obstetrics, Gynecology and Reproductive Services. The findings underscore the importance of comprehensive preoperative assessment, particularly for elderly patients who may require additional support and planning.
Perioperative Outcomes
The study revealed notable differences in perioperative morbidity between elderly and non-elderly patients:
- Non-home discharge: 5.2% vs 1.6% (P = .001)
- Emergency department visits: 8.4% vs 11.6%
- Readmission rates: 7.6% vs 7.9%
These findings emphasize the need for tailored perioperative care strategies for elderly and frail patients, suggesting that standard ERAS protocols alone may not be sufficient for this vulnerable population.
