title: Modified frailty index associated with Clavien-Dindo IV complications in robot-assisted radical prostatectomies: A retrospective study.
abstract: To determine the effect of frailty on patient outcomes including any complication, Clavien-Dindo IV (CDIV) (intensive care unit-level) complications, and 30-day mortality for robotic-assisted radical prostatectomies (RARP) patients in comparison to other predictive indices using the modified frailty index (mFI).
  
  
  
  Patients undergoing RARP from 2008 to 2014 for a prostate cancer-related diagnosis were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The mFI was developed using the Canadian Study of Health and Aging Frailty Index as a model. The mFI was compared with other associative indices such as the American Society of Anesthesiology (ASA) classification and the Charlson comorbidity index (CCI). Rates of CDIV complications and 30-day mortality were analyzed based on mFI score using SAS version 9.22.
  
  
  
  A total of 23,104 patients undergoing RARP were queried. RARP patients with the highest frailty score (≥3) had an adjusted odds for CDIV complications of Odds ratio of 12.107 (CI: 2.800-52.351, P< 0.005) in comparison with nonfrail RARP patients. These odds were higher than the ASA and Charlson comorbidity index. Additionally, a variable combining mFI and ASA had fair sensitivity and specificity for predicting 30-day mortality in RARP patients (C-statistic = 0.7097, P<0.0001).
  
  
  
  Increasing mFI scores are associated with worsening outcomes for patients undergoing RARP. A combined mFI and ASA variable can be used to predict 30-day mortality for RARP patients better than mFI or ASA alone.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Isaiah.Levy@icahn.mssm.edu.
authors.forename: Isaiah
authors.initials: I
authors.lastname: Levy
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Finkelstein
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Khawaja Hassan
authors.initials: KH
authors.lastname: Bilal
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Palese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000073496:Frailty; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects*
keywords: Clavien-Dindo IV complications; Elderly; Frailty; Robot-assisted radical prostatectomy