Peri-operative care of Older People undergoing Colorectal Surgery in a District General Hospital

Background Older adults undergoing colorectal cancer (CRC) surgery frequently live with frailty, yet frailty assessment is inconsistently embedded in surgical pathways. We evaluated a consultant‐led, joint anaesthesia–geriatrics peri-operative service incorporating Comprehensive Geriatric Assessment (CGA) and shared decision-making (SDM) in a district general hospital. Methods Single-centre retrospective cohort of consecutive patients aged ≥65 years referred to a peri-operative frailty–anaesthesia clinic (23 September 2021–28 December 2023). CGA was delivered alongside anaesthetic pre-assessment before elective colorectal procedures. Primary outcomes were length of stay (LOS), 30- and 90-day mortality and 30-day readmission. Secondary outcomes included surgical approach, associations with Clinical Frailty Scale (CFS), new diagnoses, and deprescribing. Results Of 197 patients reviewed (median age 81 years; ~50% CFS ≥4), 148 underwent surgery. Median postoperative LOS was 6 days overall and was shorter after laparoscopic versus open/converted surgery (6.0 vs 11.5 days). There were no deaths at 30 or 90 days and the 30-day readmission rate was 12.8%. Frailty was associated with prolonged stay: CFS correlated with LOS (r=0.33, p<0.001); patients with CFS ≥5 had a median LOS of 13 days and a six-fold higher risk of LOS >10 days (relative risk 6.25). Approximately 25% were managed non-operatively. CGA yielded new diagnoses in 5% and deprescribing in 14%, with estimated savings of £14.93 per patient-year. Conclusions Embedding CGA and SDM upstream in the CRC pathway in a district general hospital was feasible and associated with zero short-term mortality, shorter LOS, and fewer readmissions, while improving medical optimisation. Findings support wider adoption and prospective multicentre evaluation.