OBJECTIVES: As developed countries' populations age, the number of older individuals undergoing surgery for urological disorders is on the rise. Preoperative frailty evaluation has been linked to worse postoperative outcomes. We sought to assess the impact of frailty on short-term postoperative complications among elderly patients undergoing major urological procedures.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to retrieve patients ≥65 years who underwent either radical cystectomy (RC), nephrectomy (NEP), or radical prostatectomy (RP) between 2014 and 2020. Five-item Frailty Index (FFI), a shortened version of the validated 11-item modified Frailty Index (mFI) was calculated in order to measure frailty. It is consisted of four categories: non-frail, mildly frail, moderately frail and frail (FFI= 0, 1, 2 and ≥3 respectively). We evaluated 30-day postoperative complications and readmissions using multivariate logistic regression.

RESULTS: Overall, 59,558 cases were identified. Most underwent RP (49.1%), followed by NEP (34.2%) and RC (16.7%). Higher frailty scores were associated with increased overall postoperative complications (mildly frail OR: 1.14 [1.00-1.31]; moderately frail OR: 1.29 [1.04-1.60]; frail OR: 1.57 [1.14-2.17]). These findings were most prominent in RC patients aged 70-74 (frail OR: 5.65 [1.34-24.3]). Across all 3 procedures, frail individuals also had higher risk of readmission (mildly frail OR: 1.29 [1.09-1.52]; moderately frail OR: 1.34 [1.04-1.74]; frail OR: 1.60 [1.09-2.37]). However, this association was not significant across age groups for RP and NEP patients.

CONCLUSIONS: This study suggests that frailty in older patients undergoing major urological surgeries increases the risk of postoperative complications and readmission, particularly for RC patients where the impact of frailty increases with age. This highlights the need for preoperative frailty assessment in this vulnerable patient population to improve quality of care.