The following is a summary of “Comparing Frailty Indices for Risk Stratification in Urologic Oncology: Which Index to Choose?,” published in the August 2024 issue of Urology by Deol et al.

This study aimed to determine the optimal frailty screening tool for surgical risk stratification by comparing the predictive capabilities of the Modified Frailty Index (mFI) and the revised Risk Analysis Index (RAI-Rev) in forecasting perioperative outcomes among patients undergoing major urologic oncologic procedures. Utilizing data from the National Surgical Quality Improvement Program (NSQIP) between 2013 and 2017, researchers identified patients who underwent radical prostatectomy, partial or radical nephrectomy, and radical cystectomy. Investigators employed multivariable logistic regression analyses to examine the associations of mFI and RAI-Rev scores with 30-day perioperative outcomes, including major complications, Clavien grade ≥4 complications, non-home discharge, 30-day readmission, and all-cause mortality.

Receiver-operating characteristic (ROC) curve analyses were conducted to compare the predictive performances of the two frailty instruments. DeLong’s test assessed the statistical significance of differences between their C-statistics. The study cohort comprised 101,739 patients, revealing 30-day significant complication rates ranging from 2.40% for prostatectomy to 26.86% for cystectomy, non-home discharge rates between 1.92% and 13.54%, and mortality rates spanning from 0.16% to 1.43%. The RAI-Rev demonstrated superior discriminatory ability for predicting mortality, with C-statistics between 0.688 and 0.798, and for predicting non-home discharge, with C-statistics ranging from 0.638 to 0.734, compared to the mFI, which exhibited C-statistics of 0.594 to 0.677 for mortality and 0.593 to 0.639 for non-home discharge. Both indices showed comparable predictive performance for major perioperative complications, with C-statistics between 0.531 and 0.607. DeLong’s test confirmed that the differences in predictive accuracy between RAI-Rev and mFI for mortality and non-home discharge were statistically significant (p<0.001) across all surgical categories examined. 

These findings suggest that the RAI-Rev may be a more effective frailty prognostic tool than the mFI for patients undergoing major urologic surgeries, particularly in predicting mortality and discharge outcomes. Consequently, prospective studies and clinical trials focusing on frailty assessments in surgical populations should consider incorporating the RAI-Rev into their design to enhance risk stratification and patient management strategies.

Source: sciencedirect.com/science/article/abs/pii/S0090429524007441