Predictive value of G8 screening tool for ambulation failure and severe complications in the perioperative period:...

Older patients undergoing major urological cancer surgery are at increased risk of postoperative functional decline and complications, including ambulation failure, which can delay recovery, prolong hospitalization, and reduce independence. Although perioperative rehabilitation may improve outcomes, identifying patients who would benefit the most remains challenging. The Geriatric-8 (G8) screening tool is a simplified frailty assessment, but its predictive value for postoperative ambulation failure in this population has not been fully investigated. This study aimed to evaluate whether the G8 score can predict postoperative ambulation failure and high-grade complications in older adults undergoing major urological cancer surgery.

This retrospective study analyzed 1754 patients who underwent major urological cancer surgery (radical cystectomy, radical prostatectomy, radical nephrectomy, partial nephrectomy, and radical nephroureterectomy) at a single tertiary center between January 2020 and December 2024. Preoperative G8 assessments were performed, and patients were classified as normal (G8 > 14) or abnormal (G8 ≤ 14). The primary endpoint was postoperative ambulation failure, and the secondary endpoint was high-grade postoperative complications (Clavien-Dindo classification grade ≥ 3). Logistic regression models were conducted to identify predictors of these outcomes, and the discriminative ability of the G8 score was assessed using receiver operating characteristic (ROC) curve analysis.

Of the 1754 included patients (median age 73 years [IQR: 69-77]; 89.3% male), 784 (44.7%) had an abnormal G8 score. Postoperative ambulation failure was significantly more common in the abnormal G8 group (9.2% vs. 1.1%, P < 0.001). In multivariable analysis, an abnormal G8 score (odds ratio [OR] 5.75, 95% confidence interval [CI] 2.99-11.1), American Society of Anesthesiologists physical status ≥3 (OR 4.90, 95% CI 2.42-9.93), and radical cystectomy (OR 7.08, 95% CI 3.68-13.6) were independently associated with postoperative ambulation failure. Abnormal G8 scores were independently associated with high-grade postoperative complications (OR 2.00, 95% CI 1.01-3.96). ROC analysis demonstrated good discriminative ability of the G8 score for predicting ambulation failure (area under the curve 0.787, 95% CI 0.750-0.823).

An abnormal preoperative G8 score was independently associated with postoperative ambulation failure and high-grade complications in patients who underwent major urological cancer surgery. Incorporating the G8 screening tool into preoperative assessments may help identify high-risk patients who could benefit from early rehabilitation and tailored perioperative management. Future prospective studies are warranted to validate these findings and evaluate the impact of G8-based interventions on postoperative recovery.