Dynamic frailty trajectories identify thymoma patients at high risk of postoperative muscle weakness

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BACKGROUND: Thymoma is the most common anterior mediastinal tumor and poses significant postoperative challenges, including muscle weakness. Frailty is a multidimensional syndrome linked to poor surgical outcomes and remains understudied in thymoma. This study investigates the impact of preoperative frailty and its dynamic trajectories on postoperative muscle weakness. METHODS: A retrospective cohort of 531 thymoma patients (2015-2025) was recruited. Frailty was assessed pre- and postoperatively using the Rockwood Frailty Index (FI), categorized as robust (FI ≤ 0.10), pre-frail (0.10 < FI < 0.25), or frail (FI ≥ 0.25). Postoperative muscle weakness was defined as ≥1 MRC grade decline. Cox regression models adjusted for demographics, comorbidities, and laboratory parameters evaluated associations between frailty status, ΔFI (change in FI), and outcomes. RESULTS: Among 405 analyzed patients, pre-frail (HR = 1.70, 95%CI: 1.38-2.02) and frail (HR = 1.83, 95%CI: 1.51-2.15) individuals had significantly higher muscle weakness risks versus robust. Frailty progression (ΔFI increase) raised risk by 41% (HR = 1.41, 95%CI: 1.22-1.60), while recovery reduced it by 31% (HR = 0.69, 95%CI: 0.58-0.81). Cumulative FI (upper tertile HR = 2.85, 95%CI: 2.64-3.03) and ΔFI (upper tertile HR = 1.83, 95%CI: 1.69-1.97) exhibited dose-dependent associations with adverse outcomes (trend P < 0.01). CONCLUSION: Preoperative frailty and its dynamic changes independently are associated with postoperative muscle weakness in thymoma patients. The Rockwood FI provides prognostic value for risk stratification, highlighting the pre-frail state as a modifiable target for prehabilitation. Integrating longitudinal frailty assessments into perioperative care may optimize recovery and survival, urging future trials to validate disease-specific thresholds and interventions.

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