How Frailty Contributes to Gut Imbalance and Post-Surgical Gastrointestinal Risks

Gastrointestinal complications such as postoperative ileus (POI) and intra-abdominal infections (IAI) remain significant issues following radical cystectomy for bladder cancer. Despite technological advances like robot-assisted surgery and enhanced recovery protocols, a considerable number of patients still experience these complications, which can lead to longer hospital stays and increased morbidity. Recognizing risk factors beyond surgical methods is crucial.

Recent research published in Scientific Reports by a team from Nagoya University and Fujita Health University sheds light on the role of gut microbiota and patient frailty in postoperative outcomes. They analyzed fecal samples from the ileum and ascitic fluid of 146 patients undergoing intracorporeal urinary diversion without prior bowel preparation, with short-term antibiotics. Results showed that while antibiotics suppressed the ileal microbiota in most, residual intra-abdominal bacteria and fungi were strongly associated with GI complications.

Lead researcher Dr. Zennami explained, "Residual microbes within the abdomen, especially in frail patients, significantly increase the risk of GI complications. Frailty appears to exacerbate microbial imbalance, particularly involving Enterococcus and Enterobacter species." The study found that patients with positive bacterial or fungal presence in their ascitic fluid had over six times higher risk of complications. Specifically, 72.5% of those with positive cultures experienced POI or infections, compared to just 11.3% with negative cultures. The presence of bacteria in ileal feces alone also doubled the risk. All cases of intra-abdominal infections occurred in patients with both positive ileal and ascitic cultures, indicating residual microbes as key contributors.

Frailty, assessed using the Geriatric-8 questionnaire, emerged as a critical factor. Frail patients were far more likely to carry residual microbes and develop postoperative complications—63% versus 12% in non-frail individuals. These patients showed a higher prevalence of organisms like Enterococcus and resistant strains, which are challenging to treat.

The findings suggest that surgical and perioperative protocols should be tailored to account for the patient's frailty and gut microbiota profile. Preoperative assessment and interventions such as nutritional support, exercise programs, and microbiota-targeted therapies like probiotics could reduce complication risks. Although the study offers valuable insights, larger multicenter trials are needed to confirm these results and develop targeted management strategies.

Dr. Zennami concluded that integrating microbiota management with frailty evaluations could revolutionize perioperative care, ultimately minimizing complications and enhancing recovery for vulnerable patients. This approach emphasizes the importance of personalized medicine in surgical outcomes.

Source: https://medicalxpress.com/news/2025-09-frailty-fuels-gut-imbalance-surgery.html