Longitudinal Interaction Between Frailty and Postoperative Symptom Burden in Older Adults Undergoing Colorectal Cancer Surgery: A Random Intercept Cross-Lagged Panel Model Study

Background/Objectives: Frailty and postoperative symptom burden are common in older adults undergoing colorectal cancer surgery, but their temporal associations remain unclear. This study examined longitudinal associations between frailty and two symptom dimensions, symptom severity and symptom interference, using the Random Intercept Cross-Lagged Panel Model (RI-CLPM).

Methods

This prospective longitudinal study enrolled 242 older adults (≥60 years) undergoing CRC surgery. Frailty and symptoms were assessed before surgery and at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. Separate RI-CLPMs were estimated for frailty with symptom severity and symptom interference. Sensitivity analyses compared results with conventional CLPMs, adjustment for time-varying albumin and body mass index, and a worst-case missing-data scenario.