Is the Modified Frailty Index-5 a reliable predictor of postoperative morbidity in elderly radical cystectomy patients? A comparative study with CCI and G8

Abstract

Objective

In this study, the success of the Modified Frailty Index-5 (mFI-5) score in predicting postoperative morbidity in elderly patients who underwent radical cystectomy (RC) for bladder cancer was evaluated, and this score was compared with the widely used Charlson Comorbidity Index (CCI) and Geriatric 8 (G8) screening tools.

Methods

Between January 2017 and April 2025, 102 patients aged ≥65 years who underwent open RS for T2–T4a N0M0 bladder cancer were retrospectively reviewed. mFI-5, CCI, and G8 scores were calculated from preoperative data. Patients were divided into two groups based on mFI-5 scores: <2 (Group 1, non-frail) and ≥2 (Group 2, frail). Major complications were defined as Clavien–Dindo (CD) ≥3. Clinical data, complication rates, hospital stay duration, and readmission rates after discharge were compared.

Results

Of the patients, 40 (39.2%) were in Group 1 and 62 (60.8%) were in Group 2. The rates of any complications and CD ≥ 3 complications were higher in Group 2 (p = 0.006 and p = 0.018, respectively). In multivariate analysis, mFI-5 ≥ 2 approximately tripled the risk of CD ≥ 3 complications (OR = 3.036; 95% CI 0.966–9.546; p = 0.043). In ROC analysis, the AUC value of mFI-5 for CD ≥ 3 complications was 0.718 (95% CI: 0.613–0.822), which was higher than that of CCI and G8. The AUC value of mFI-5 for predicting readmission was 0.704 (95% CI: 0.599–0.810).

Conclusion

mFI-5 is a practical frailty assessment tool that predicts postoperative morbidity in elderly RS patients with higher accuracy than CCI and G8.