Little is known about what are the most important factors that influence recovery in older patients after surgery. Patients in England aged 75 years or more undergoing elective colorectal surgery have a 30 day mortality of 7%. However, by one year this substantially increases to 18%. If older patients who are vulnerable to poor recovery are identified either pre-operatively or at an early stage when recovery is failing, hospital and/or community interventions may be implemented.

Elderly patients vary widely in physical, functional and cognitive performance. Quantifying the requirements of an individual to withstand the insult of major surgery is dependent upon a comprehensive understanding of their baseline functional capacity. In multiple large-scale community-based studies, frailty has been recognised as an independent predictor of falls, hospitalisation, need for institutional care and death. Furthermore, studies suggest that frailty is modifiable. Frailty has only recently begun to be investigated in surgical populations. There are currently no studies evaluating the effect of pre-operative functional status on outcome and quality of life in elderly patients up to one year following colorectal resection. Also there are no high quality studies that evaluate the trajectory of recovery in elderly patients after colorectal surgery and in the community.

The primary aim of the proposed thesis is to evaluate the recovery of elderly patients with varying degrees of preoperative frailty, in terms of quality of life after major elective colorectal resection. The secondary aims of the thesis are to investigate the relationship between preoperative frailty and mortality, complications and recovery. This will improve the quality of information available to patients with regards to their expected functional quality of life after surgery.