Stratification of surgical risk in elderly and frail patients with acute colonic obstruction using the E-POSSUM and Edmonton Frail Scale

Aim. To evaluate the clinical condition, degree of surgical risk and prognostic significance of the E-POSSUM scoring system and the Edmonton Frail Scale (EFS) in elderly and frail patients with acute colonic obstruction. Materials and methods. The study on evaluation of patients’ physiological reserve based on surgical treatment outcomes included 122 consecutive patients aged 65–89 years with acute colonic obstruction, treated at the Surgical Department of City Hospital No. 9, Zaporizhzhia, between 2022 and 2024. Patients were allocated to three treatment groups based on intraoperative findings and surgical feasibility: Group 1 patients underwent colon resection for tumor with terminal colostomy; Group 2 – colonic decompression (endoscopic stenting or transrectal intraoperative lavage) followed by radical resection with primary anastomosis; Group 3 – double-barrel stoma via minimally invasive approach, performed when adequate decompression was not achievable. Preoperative assessment included E-POSSUM scoring and EFS to quantify surgical risk and degree of frailty, respectively. The incidence of postoperative complications and mortality were analyzed. The results obtained were subjected to statistical analysis to determine the prognostic significance of the scales studied. Results. A strong positive correlation was found between the total E-POSSUM score and postoperative mortality (r = 0.64, p < 0.01), and a moderate positive correlation between EFS scores and postoperative complication rates (r = 0.52, p < 0.05). When high E-POSSUM predicted risk (>40 %) was combined with severe frailty (EFS ≥10 points), mortality reached 38.7 %. High E-POSSUM risk (>40 %) was identified preoperatively in 55 % of patients, and moderate-to-severe frailty (EFS ≥10) in 62 %. The co-occurrence of both risk indicators was significantly associated with increased mortality and postoperative complication rates (p < 0.05). Conclusions. Combined preoperative use of E-POSSUM and Edmonton Frail Scale enables more accurate surgical risk stratification in older patients with acute colonic obstruction, facilitates individualized treatment strategy selection, supports prediction of postoperative outcomes, and improvs patients’ quality of life.