Frailty and Sarcopenia in Colorectal Surgery

A recent meeting with a North-East colorectal surgical team highlighted an important goal: to optimise recovery not just by feeding patients earlier, but by better understanding who is most vulnerable before surgery. The discussion centred on updates from the ESPEN guideline on clinical nutrition in surgery (2025)¹ and the Enhanced Recovery After Surgery (ERAS) Society 2025 colorectal surgery² recommendations, with particular attention to frailty and sarcopenia as critical, and sometimes overlooked, determinants of outcome.

Traditional nutritional screening remains a cornerstone of good peri-operative care. However, both ESPEN and ERAS now emphasise the importance of identifying vulnerability in patients who present with preserved weight but reduced functional reserve. Frailty and sarcopenia provide that missing lens, capturing reduced physiological resilience, muscle strength, and functional capacity, all of which are independently associated with poorer surgical outcomes.

During the meeting, the team reflected on familiar scenarios: older patients who appear clinically stable, yet experience delayed recovery, complications, or prolonged length of stay. Updated guidance supports the routine consideration of frailty screening tools (such as the Clinical Frailty Scale) and assessment of sarcopenia alongside nutritional screening to help identify these patients earlier in the pathway.

Both ESPEN and ERAS stress that identifying frailty or sarcopenia should lead to action, not just documentation. Nutritional prehabilitation, including adequate protein intake, oral nutritional supplementation where indicated, and early escalation to enteral or parenteral nutrition when oral intake is insufficient, forms part of a wider, multimodal strategy.

Exercise, early mobilisation, and optimisation of metabolic stress are integral components of ERAS pathways and may be particularly impactful in sarcopenic patients.

What stood out from this conversation was not just the guideline updates themselves, but their relevance to day-to-day clinical decision-making. Moving from a single screening score to a broader assessment of nutritional status, frailty, and muscle health

supports more individualised care, ensuring the right patients are targeted for early intervention and prehabilitation. The team also got involved by taking part in the 5 sit-to-stand test and testing their own handgrip strength - which soon became very competitive!

As colorectal pathways continue to evolve, these conversations play a vital role in translating guidance into practice. By embedding frailty and sarcopenia assessment alongside traditional nutritional screening, teams can better anticipate risk, personalise peri-operative care, and inform pathway design for patients undergoing colorectal surgery.

By working collaboratively, together we can support more individualised perioperative care for patients. If you are interested in having one of the Fresenius Kabi Scientific Affairs team participate in your team meeting, please reach out to us; scientific.affairsUK@fresenius-kabi.com

1. Weimann, A., Bezmarevic, M., Braga, M., Correia, M.I.T., Funk-Debleds, P., Gianotti, L., Gillis, C., Hübner, M., Inciong, J.F.B., Jahit, M.S. and Klek, S., 2025. ESPEN guideline on clinical nutrition in surgery–Update 2025. Clinical Nutrition, 53, pp.222-261

2. Gustafsson, U.O., Rockall, T.A., Wexner, S., How, K.Y., Emile, S., Marchuk, A., Fawcett, W.J., Sioson, M., Riedel, B., Chahal, R. and Balfour, A., 2025. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025. Surgery, p.109397.

For healthcare professionals only

GB-NP-2600043 May 2026