Frailty and nutritional status predict postoperative complications in radical cystectomy patients

Radical cystectomy (RC) is associated with significant morbidity and mortality. While frailty and nutritional status have emerged as important predictors of surgical outcomes, their impact on RC complications remains incompletely characterized. We aimed to evaluate the relationship between frailty (using the Modified Frailty Index-5 [mFI-5], nutritional status (using the Nutritional Risk Index [NRI]), and postoperative outcomes in patients undergoing RC.

We conducted a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Frailty was defined as mFI-5 score ≥2 and malnutrition as NRI ≤97.5. Hypoalbuminemia was defined as preoperative albumin ≤3.5. Outcomes included 30-day complications, length of stay, and mortality.

Among 8297 patients, 1793 (21.6%) were classified as frail. Frail patients experienced higher rates of infectious (sepsis: 10.2% vs. 6.72%, p<0.001), cardiopulmonary (myocardial infarction: 2.56% vs. 1.09%, p<0.001), and renal (renal insufficiency: 9.53% vs. 5.23%, p<0.001) complications. Mortality was twice as high in frail patients (2.45% vs. 1.17%, p<0.001). Among 8297 patients with nutritional data, 668 (8.05%) were malnourished, and 910 (15.2%) had hypoalbuminemia. Malnourished patients had higher rates of transfusion requirements (46.4% vs. 24.9%, p<0.001) and mortality (2.54% vs. 1.35%, p=0.032). Hypoalbuminemic patients demonstrated increased major complications (56.7% vs. 38.5%, p<0.001). The predictive accuracy of these indices varied by outcome, with area under the curve values ranging from 0.53-0.63.

Both frailty and poor nutritional status are associated with increased postoperative complications and mortality following RC; however, the modest predictive accuracy of these indices indicates they should be used as part of a broader risk assessment strategy.