The Impact of Preoperative Frailty on Postoperative Complications in Elderly Patients Undergoing Urological Malignancy Surgery

Frailty is defined as decreased physiological reserve throughout multiple organ systems. With an increasing rate of elective operations in the aging population, the outcome of surgery on frail patients has become important. We aimed to determine if “frailty” predicts surgical complications according to Clavien-Dindo classification after urological surgeries in elderly patients. After ethical committee approval, records of the patients who had undergone transurethral resection of the prostate and bladder, radical or partial nephrectomy, and radical prostatectomy were detected. Frailty was classified using a 15-point validated scale as modified frailty index (mFI). Patients with a score of 3 or more were classified as frail, 1, 2 were intermediately frail, and 0 were non-frail. Main outcome measures were 30-day surgical complications according to Clavien-Dindo classification and length of stay (LOS) at hospital. A total of 250 patients were queried. The mean age of the patients was 73.2 ± 6.26. In the mFI = 2 and mFI ≥ 3 groups, Clavien-Dindo grade III ratio was significantly higher than the mFI = 0 and mFI = 1 groups. Therefore, as the level of the mFI increased, so did the Clavien-Dindo grade. LOS at the hospital in mFI ≥ 3 group was significantly higher than other groups. In conclusion, increased mFI scores are associated with worsened surgical outcomes and prolonged LOS in elderly patients undergoing urological operations. The findings of our study showed that a 15-point mFI assessment may be useful for predicting surgical postoperative adverse complications in patients over 65 years of age undergoing urological malignancy surgeries.