# Preoperative Cognitive Function and Physical Frailty Predict Decision Satisfaction and Postoperative Adherence in Older Gynecologic Oncology Patients: A Prospective Observational Study

## TL;DR

This study shows that preoperative cognitive function better predicts postoperative recovery and satisfaction in older gynecologic cancer patients than physical frailty.

## Contribution

The study demonstrates that cognitive screening before surgery can help predict recovery and decision satisfaction in older patients.

## Key findings

- Higher cognitive scores were linked to faster recovery, shorter hospital stays, and better adherence to postoperative care.
- Cognitive function was a stronger predictor of decision satisfaction than physical frailty.
- Cognitive screening could help identify patients needing more postoperative support.

## Abstract

As the population ages, an increasing number of older women undergo surgery for gynecologic cancers, yet predicting recovery and engagement in postoperative care remains challenging. This study explored whether simple preoperative assessments of cognitive function and physical frailty could help predict how well patients recover after surgery, adhere to recommended care, and feel satisfied with their surgical decision. We found that cognitive function before surgery was a stronger predictor of postoperative recovery behaviors and decision satisfaction than physical frailty. Patients with lower cognitive scores were more likely to experience complications, delayed recovery, and poorer adherence to postoperative recommendations. These findings suggest that routine cognitive screening before surgery may help clinicians identify patients who need additional support, enabling more personalized care and potentially improving postoperative support and outcomes for older women with gynecologic cancers.

With increasing life expectancy, a growing proportion of patients undergoing surgery for gynecologic cancers are older adults, underscoring the need for reliable predictors of postoperative recovery and patient engagement. Cognitive function and physical frailty are recognized determinants of surgical outcomes, yet their relative impact on patient centered outcomes remains insufficiently explored. This prospective observational study included 68 women aged 65 years and older who underwent abdominal surgery for gynecologic malignancies. Preoperative cognitive function was assessed using the Montreal Cognitive Assessment, and physical frailty was evaluated with the Clinical Frailty Scale. Postoperative outcomes included early recovery parameters, complications, surgical decision satisfaction, and home-based adherence. Higher cognitive scores were associated with earlier mobilization, shorter hospital stay, better postoperative adherence, and greater decision satisfaction, whereas higher frailty scores were associated with delayed recovery and increased complication risk. In regression analyses, preoperative cognitive function was significantly associated with both postoperative adherence and surgical decision satisfaction, whereas physical frailty was not. These findings indicate that preoperative cognitive screening may have predictive value for patient centered recovery behaviors and decision satisfaction in this setting; however, the prediction estimates should be considered exploratory and warrant validation in larger, multicenter cohorts.