Chronological age and failure to rescue after colorectal cancer surgery: A multicentre cohort study

BACKGROUND: Whether advancing chronological age is associated more strongly with serious postoperative events or with survival after an event remains uncertain. AIMS: To compare the association of chronological age with major postoperative events and failure to rescue after colorectal cancer surgery. METHODS: We analyzed 1,124 adults treated at five Polish centers between January 2022 and August 2025. Major events were Clavien-Dindo ≥grade IIIa; failure to rescue was cumulative 90-day death after such an event. Chronological age was analysed per 10-year increase. Multivariable logistic regression examined major events and Firth regression examined failure to rescue. RESULTS: Major events occurred in 145 patients; failure to rescue was evaluable in 134 and occurred in 24. Chronological age was not associated with major events (adjusted odds ratio per decade 1.09, 95% confidence interval 0.89-1.33) or nonfatal major morbidity. Failure-to-rescue odds increased per decade (odds ratio 2.02, 95% confidence interval 1.21-3.63); model-standardized probabilities were 11.1% at age 65 and 32.5% at age 85 years. Sensitivity analyses were directionally consistent, but the interval included no association when every model-eligible missing post-event outcome was assigned to death. DISCUSSION: The chronological-age gradient was concentrated in survival after a serious event. Frailty and physiological reserve were not measured; reduced reserve remains a plausible explanation rather than a demonstrated mechanism. CONCLUSIONS: Chronological age may help identify patients who warrant intensified postoperative surveillance and early escalation, while formal geriatric and frailty assessment remains necessary to characterize biological vulnerability.