Abstract: Objective To explore the factors influencing early recovery quality after radical surgery for colorectal cancer in elderly patients and establish a prediction model. Methods A total of 182 elderly patients who underwent elective radical surgery for colorectal cancer at the Affiliated Hospital of Yangzhou University between May 2023 and May 2024 were enrolled as study objects. Data such as gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, albumin, serum creatinine, hemoglobin, and D-dimer levels at admission were collected. Surgical approach, operative time, anesthesia time, length of hospital stay, and whether the patient was transferred to the intensive care unit (ICU) postoperatively were also recorded. Relevant patient information was compiled through the electronic medical record system to calculate the modified frailty index (mFI). The 15-item Quality of Recovery Scale (QoR-15) was used to assess patients' recovery quality three days postoperatively. Results A total of 163 patients had good recovery (QoR-15 score ≥120) and 19 had poor recovery (QoR-15 score<120). Preoperative mFI (≥0.27) and BMI (≥21.05 kg/m²) were identified as factors influencing early recovery quality after radical surgery for colorectal cancer in elderly patients. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model of recovery quality after radical surgery for colorectal cancer in elderly patients was 0.816 (95%CI: 0.710～0.921), indicating good agreement between the model's predicted recovery quality and actual recovery quality, indicating high discrimination and accuracy. Conclusion Preoperative mFI (≥0.27) and BMI (≥21.05 kg/m²) are factors influencing recovery quality after radical surgery for colorectal cancer in elderly patients. Improving perioperative frailty status and appropriately regulating BMI levels can help reduce the risk of postoperative complications.