BACKGROUND: The value of performance status is widely used in medical oncology, but the association with surgical outcomes in colorectal cancer has not been described. OBJECTIVE: The aim of this study was to investigate the association between World Health Organization performance status and 90-day mortality, 30-day mortality, complications, and overall survival after elective colorectal cancer surgery. DESIGN: The study was conducted as a nationwide population-based cohort study with prospectively collected data. SETTING: Data from 2014 through 2016 were provided by the Danish nationwide colorectal cancer database (Danish Colorectal Cancer Group). PATIENTS: All patients aged ≥18, who had elective surgery for colorectal cancer were included. MAIN OUTCOME MEASURES: Multiple logistic regressions were performed to investigate 90-day mortality, 30-day mortality, and complications. One-year mortality was determined by Cox regression, and overall survival was illustrated by Kaplan-Meier curves. RESULTS: A total of 10,279 patients had elective colorectal cancer surgery during the study period (6892 colonic and 3387 rectal). Thirty-four percent of the patients with colorectal cancer had a World Health Organization performance status ≥1. The odds ratios of postoperative 90-day mortality in colon cancer for performance status 1, 2, and 3/4 compared with performance status 0 were 2.50 (95% CI, 1.67-3.73), 5.00 (95% CI, 3.19-7.86), and 17.34 (95% CI, 10.18-29.55). The odds ratios of postoperative 90-day mortality in rectal cancer for performance status 1, 2, and 3/4 were 3.90 (95% CI, 2.23-6.85), 9.25 (95% CI, 4.75-18.02), and 10.56 (95% CI, 4.07-27.41). Performance status was also associated with 30-day mortality, overall survival, and medical complications. LIMITATIONS: Only 1 year of follow-up was possible for all patients, and cancer-specific survival was not available. CONCLUSION: One of three patients has a performance status >0 and is associated with an increased risk of death, complications, and overall survival for both colonic and rectal cancers. See Video Abstract at http://links.lww.com/DCR/B540.