{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:17:19Z","timestamp":1783426639157,"version":"3.54.6"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Frailty is increasingly recognized as a major determinant of postoperative outcomes in older patients undergoing oncologic surgery. The Primary Care Frailty Index (PC-FI), a deficit accumulation-based instrument derived from routinely available clinical information, has recently been proposed as a practical frailty assessment tool. However, evidence supporting its application in gastrointestinal surgical oncology remains limited. Methods: We conducted a retrospective cohort study including patients aged \u226565 years who underwent elective major colorectal or gastric cancer surgery between January 2022 and October 2025 at a tertiary Italian hospital. Patients with a PC-FI &gt; 0.07 were included and categorized as having mild (0.07\u20130.13) or moderate-to-severe frailty (\u22650.14). Postoperative outcomes included the Comprehensive Complication Index (CCI), Clavien\u2013Dindo classification, and length of hospital stay. Receiver operating characteristic (ROC) analysis was performed to compare the discriminative performance of PC-FI, ASA classification, and the ACS Surgical Risk Calculator. Results: Ninety-two patients met the inclusion criteria. Patients with moderate-to-severe frailty were significantly older and had higher ASA class, Charlson Comorbidity Index, and ACS morbidity estimates than mildly frail patients. They also experienced a greater postoperative complication burden (mean CCI 25.96 vs. 16.40, p = 0.02) and longer hospital stay (9.89 vs. 7.43 days, p = 0.01). ROC analysis demonstrated modest discriminative performance for PC-FI (AUC 0.63), comparable to ASA classification (AUC 0.68) and the ACS morbidity score (AUC 0.70), without statistically significant differences among the three instruments. Conclusions: Higher PC-FI scores were associated with increased postoperative morbidity and prolonged recovery following major gastrointestinal oncologic surgery. Although its discriminative performance was modest and does not support its use as a stand-alone risk prediction tool, the PC-FI may represent a simple first-line frailty screening instrument to identify older patients who could benefit from comprehensive multidisciplinary perioperative assessment.<\/jats:p>","DOI":"10.3390\/jcm15135158","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:48:32Z","timestamp":1782992912000},"page":"5158","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of the Primary Care Frailty Index with Postoperative Outcomes in Older Patients Undergoing Major Gastrointestinal Oncologic Surgery: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3800-8943","authenticated-orcid":false,"given":"Andrea","family":"Costanzi","sequence":"first","affiliation":[{"name":"General Surgery Unit, San Leopoldo Mandic Hospital, ASST Lecco, 23807 Merate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Fazzini","sequence":"additional","affiliation":[{"name":"General Surgery Unit, San Leopoldo Mandic Hospital, ASST Lecco, 23807 Merate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5534-8052","authenticated-orcid":false,"given":"Lara","family":"Verdi","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, San Leopoldo Mandic Hospital, ASST Lecco, 23807 Merate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1202-5454","authenticated-orcid":false,"given":"Paolo Dionigi","family":"Rossi","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, San Leopoldo Mandic Hospital, ASST Lecco, 23807 Merate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Enoc","family":"Chiarelli","sequence":"additional","affiliation":[{"name":"General Surgery Unit, San Leopoldo Mandic Hospital, ASST Lecco, 23807 Merate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Bonfanti","sequence":"additional","affiliation":[{"name":"General Surgery Unit, San Leopoldo Mandic Hospital, ASST Lecco, 23807 Merate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6811-9305","authenticated-orcid":false,"given":"Paolo","family":"Aseni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Clegg, A., and Rockwood, K. (2018). Fifteen years of progress in understanding frailty and health in aging. BMC Med., 16.","DOI":"10.1186\/s12916-018-1223-3"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1093\/gerona\/62.7.722","article-title":"Frailty in relation to the accumulation of deficits","volume":"62","author":"Rockwood","year":"2007","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_5","first-page":"505","article-title":"Nonlinear dynamics of frailty and aging: Implications for ageing research and clinical practice","volume":"36","author":"Rockwood","year":"2007","journal-title":"Age Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.arr.2015.12.003","article-title":"Frailty Assessment Instruments: Systematic Characterization of the Uses and Contexts of Highly-Cited Instruments","volume":"26","author":"Buta","year":"2016","journal-title":"Ageing Res. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.jamda.2009.11.008","article-title":"Determinants of frailty","volume":"11","author":"Gobbens","year":"2010","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Novelli, G., Calcaterra, G., Casciani, F., Pecorelli, S., and Mehta, J.L. (2024). Exerkines: A Comprehensive Term for the Factors Produced in Response to Exercise. Biomedicines, 12.","DOI":"10.3390\/biomedicines12091975"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.cger.2015.04.005","article-title":"Sarcopenia as the biological substrate of physical frailty","volume":"31","author":"Landi","year":"2015","journal-title":"Clin. Geriatr. Med."},{"key":"ref_10","first-page":"329","article-title":"Frailty and sarcopenia: What exactly is the difference?","volume":"5","author":"Lee","year":"2014","journal-title":"Eur. Geriatr. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1038\/s41392-024-01954-6","article-title":"Metabolic Regulation of the Immune System in Health and Diseases: Mechanisms and Interventions","volume":"9","author":"Hu","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1001\/jamasurg.2023.0198","article-title":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","volume":"158","author":"Molenaar","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1200\/JCO.21.00143","article-title":"Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care","volume":"39","author":"Montroni","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_14","first-page":"CD013259","article-title":"Prehabilitation Versus No Prehabilitation to Improve Functional Capacity, Reduce Postoperative Complications and Improve Quality of Life in Colorectal Cancer Surgery","volume":"5","author":"Molenaar","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jamasurg.2019.5474","article-title":"Effect of Multimodal Prehabilitation for Frail Patients Undergoing Colorectal Cancer Resection","volume":"155","author":"Carli","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_16","unstructured":"United Nations Department of Economic and Social Affairs, and Population Division (2023). World Population Ageing 2023, United Nations."},{"key":"ref_17","unstructured":"Organisation for Economic Co-operation and Development (OECD) (2024). Ageing 2024, OECD Publishing."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","article-title":"Frailty: Implications for clinical practice and public health","volume":"394","author":"Hoogendijk","year":"2019","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.mad.2004.05.003","article-title":"Changes with age in the distribution of a frailty index","volume":"125","author":"Rockwood","year":"2004","journal-title":"Mech. Ageing Dev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Maeda, H., Takahashi, M., Seo, S., and Hanazaki, K. (2023). Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty. J. Clin. Med., 12.","DOI":"10.3390\/jcm12155041"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1245\/s10434-018-6983-7","article-title":"The age of talking of age alone is over","volume":"26","author":"Shahrokni","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1093\/ageing\/afy110","article-title":"The prevalence of frailty and its association with clinical outcomes in general surgery: A systematic review and meta-analysis","volume":"47","author":"Hewitt","year":"2018","journal-title":"Age Ageing"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Birkelbach, O., M\u00f6rgeli, R., Spies, C., Olbert, M., Weiss, B., Brauner, M., Neuner, B., Francis, R.C.E., Treskatsch, S., and Balzer, F. (2019). Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines\u2014A retrospective observational study. BMC Anesthesiol., 19.","DOI":"10.1186\/s12871-019-0880-x"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.surge.2022.06.001","article-title":"Impact of frailty on oncological outcomes in patients undergoing surgery for colorectal cancer\u2014A systematic review and meta-analysis","volume":"21","author":"Davey","year":"2023","journal-title":"Surgeon"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/DCR.0000000000001998","article-title":"Predicting Anastomotic Leak after Elective Colectomy: Utility of a Modified Frailty Index","volume":"65","author":"Dressler","year":"2022","journal-title":"Dis. Colon Rectum"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3543","DOI":"10.1038\/s41598-023-30350-3","article-title":"Frailty detection among primary care older patients through the Primary Care Frailty Index (PC-FI)","volume":"13","author":"Vetrano","year":"2023","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5158\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:38:12Z","timestamp":1783424292000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":26,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135158"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135158","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}