A 5-Item Frailty Index for Predicting Morbidity and Mortality After Radical Prostatectomy: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database

Introduction: Current preoperative evaluation methods fail to detect the difference in frailty among patients with the same chronological age. Hence, we sought to assess the ability of a simple 5-item frailty index (5-iFI) score to predict surgical outcomes post radical prostatectomy (RP). Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried for patients who underwent RP between 2008 and 2017. The 5-iFI score was calculated by assigning a point for each of the following conditions: (1) chronic obstructive pulmonary disease or pneumonia, (2) congestive heart failure, (3) dependent functional status, (4) hypertension, and (5) diabetes. Multivariable regression was performed to assess the association between the 5-iFI score and perioperative outcomes. Results: The cohort included 15,546 (46.2%), 14,541 (46.2%), and 3556 (10.6%) patients with 5-iFI scores of 0, 1, and >= 2, respectively. Patients >65 years, nonwhite, and with an American Society of Anesthesiology >= 3 were more likely to have a 5-iFI score >= 2 (p < 0.0001). Similarly, a 5-iFI >= 2 score was associated with higher Clavien-Dindo grades complications (p-trend <0.0001). In addition, a 5-iFI score >= 2 had 1.66 (1.31-2.11) and 1.85 (1.39-2.46) times the odds of Clavien-Dindo grades >= 3 and >= 4 adverse events, respectively. Moreover, a 5-iFI score >= 2 had 28% increased risk of length of stay >1 day (p < 0.0001) and increased incidence of early mortality (p = 0.01). Conclusions: Frailty, as measured by a simple 5-point frailty index, is an independent predictor of adverse outcomes and early mortality in patients undergoing RP. Preoperative frailty assessment may improve risk stratification and patient counseling before surgery.