Robotic-assisted radical prostatectomy is pushing the boundaries: a national survey of frailty using the national surgical quality improvement program

Background:Robotic-assisted radical prostatectomy (RARP) has been found to be comparable and, in some cases, favorable to open surgical approaches, while being used in a frailer population. Objectives:We aimed to illustrate the trend in population frailty and compare morbidity and mortality postoperatively in patients who underwent RARP. Design and Methods:The National Surgical Quality Improvement Program data set was used to select patients who underwent RARP between the years 2011-2019. Age, frailty indicators, surgical characteristics, and perioperative morbidity and mortality were compared between the years 2011-2019 using the chi-square test (chi(2)) for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables. Results:Our patient population consisted of 66,683 patients who underwent RARP. There was an increase in mean age and frailty indicated by an increase in 5-item frailty score > 2, metabolic syndrome index = 3, and American Society of Anesthesiologists' (ASA) class > 3 between the years 2011-2019 (p < 0.001). Whereas the rate of mortality and morbidity, indicated by postoperative Clavien-Dindo grade > 4 and major morbidity, remained the same over the same period (p > 0.264). Furthermore, operative time and length of stay decreased over the same period (p < 0.001). Conclusion:RARP is being performed on more frail patients, with no added morbidity or mortality.