Readmission Rates and Predictive Factors in Older Patients Undergoing Colorectal Cancer Surgery: A Multicenter European Retrospective Study

Purpose: In the era of enhanced recovery pathways, hospital readmission after colorectal surgery remains a relevant issue in older patients and may reflect suboptimal perioperative management. This multicenter retrospective study aimed to identify risk factors for 30-day readmission following elective colorectal cancer surgery in patients aged ≥70 years. Methods: Clinical records from three European high-volume centers were retrospectively analyzed. A total of 1126 patients aged ≥70 years undergoing elective colorectal cancer surgery were included; urgent and emergency procedures were excluded. Preoperative assessment comprised ASA class, ECOG status, Age-Adjusted Charlson Comorbidity Index (ACCI), functional status, and frailty evaluation using the Flemish Triage Risk Screening Tool (fTRST) and G8 score. Surgical variables included operative approach and procedure type. Postoperative outcomes included Clavien-Dindo complications, Comprehensive Complication Index (CCI), anastomotic leak, and length of stay. Univariable and multivariable logistic regression analyses were performed to identify predictors of 30-day readmission. Results: The cohort included 1126 patients (51.1% male) with a mean age of 79 ± 5.6 years. The 30-day readmission rate was 6.9%. On univariable analysis, male sex, ACCI >6, ASA >2, fTRST >2, and stoma presence were associated with readmission. Multivariable analysis identified male sex (OR 1.79), fTRST >2 (OR 1.87), and ileostomy (OR 2.08) as independent predictors. Mean length of stay was 8 ± 7.6 days, mean CCI 12.2 ± 9.8, and anastomotic leak rate 9.2%. Conclusion: Male sex, preoperative frailty, and ileostomy independently predict 30-day readmission after colorectal cancer surgery in older patients. Tailored perioperative care pathways beyond standard enhanced recovery protocols reduce readmission rates and improve outcomes in this vulnerable population.