Impact of Preoperative Frailty on Postoperative Complications and Cognitive Impairment in Liver Cancer Patients: An Observational Cohort Study

Background: Frailty is characterized by an age-related decline in physiological reserve and is closely linked to postoperative outcomes. Early identification of preoperative frailty is therefore essential. This study aims to examine the associations between preoperative frailty and postoperative complications and cognitive impairment in patients with liver cancer, and to identify potential contributing factors. Methods: This observational cohort study was conducted at the Affiliated Hospital of Jiangnan University from February to June 2025 and included 115 patients with liver cancer who underwent surgery. Frailty status was assessed using the Fried Phenotype criteria on 1 day before surgery, and cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) on postoperative day 3. Postoperative complications occurring before discharge were also recorded. Results: A total of 43 patients (37.4%) developed postoperative complications, which may have been associated with preoperative frailty and its components, including exhaustion, grip strength, and low physical activity. Moreover, significantly higher prevalences of postoperative hypoproteinemia and liver function impairment, as well as markedly lower MoCA scores in unadjusted comparisons on postoperative day 3 (continuous outcome) were observed in patients with preoperative frailty. Receiver operating characteristic (ROC) analysis indicated that the frailty score may serve as a predictor of postoperative complications. Conclusion: Preoperative frailty in patients with liver cancer may be associated with postoperative complications, and the frailty score may potentially serve as a predictor of these complications. Keywords: frailty, liver cancer, postoperative complications, cognitive impairment