Frailty Matters: The Success of the Modified Frailty Index-5 Score in Predicting Postoperative Outcomes in Radical Prostatectomy

Abstract

Objective: Patients undergoing radical prostatectomy generally belong to an older population; therefore, in addition to chronological age, frailty has a substantial impact on clinical outcomes. This study aimed to evaluate the predictive value of the modified frailty index (mFI-5) for post-operative complications and functional outcomes in patients undergoing radical prostatectomy.Materials and Methods: A retrospective analysis was conducted on 200 individuals who underwent radical prostatectomy between January 2016 and January 2024 in a high-volume tertiary center. Data collection included demographic characteristics, comorbidity profiles, histopathological findings, perioperative variables, postoperative complications and follow-up outcomes. Patients were stratified as having either high risk (≥ 2) or low risk (< 2) according to pre-operative mFI-5 scores. Postoperative complications constituted the primary endpoint, whereas functional outcomes were assessed as secondary endpoints.Results: The study included 200 male patients, with a mean age of 64.7 ± 6.03 years. Fifty-four out of 200 patients (27%) were in the high-risk group (mFI-5 ≥ 2) while 146 patients (73%) were in low-risk group (mFI-5 < 2). While the rate of major complications (Clavien-Dindo ≥ 3) was significantly higher in high-risk group, the overall complication rate was similar between the groups. Readmission and reoperation rates were increased in the high-risk group; however, the difference did not reach statistical significance. Regarding functional outcomes, erectile dysfunction and urinary incontinence rates were similar between the groups.Conclusion: This study highlights an association between higher mFI-5 scores and an increased risk of major postoperative complications after radical prostatectomy. Although mFI-5 should not be used as a stand-alone criterion for treatment selection, it may serve as a simple, rapid, and cost-effective adjunctive tool for preoperative risk stratification and individualized surgical decision-making.