Frailty index and nutrition status impact perioperative outcomes in patients undergoing minimally invasive radical nephrectomy.

Frailty and malnutrition are recognized risk factors for poor surgical outcomes, yet their specific impact on perioperative outcomes in patients undergoing minimally invasive radical nephrectomy (RN) remains underexplored. This study aims to evaluate how frailty, as measured by the Modified 5-Item Frailty Index (mFI-5), and nutritional status, via the Nutritional Risk Index (NRI), affects short-term outcomes in patients undergoing minimally invasive RN. A retrospective analysis was conducted using the ACS-NSQIP database (2019-2022), identifying 7324 patients who underwent minimally invasive RN. Frailty was defined by an mFI-5 score ≥ 2, and malnutrition was identified with an NRI ≤ 97.5. Outcome measures included hospital length of stay, operative time, major complications, and mortality. Statistical analysis involved logistic regression to assess associations, with odds ratios (OR) and 95% confidence intervals (CI). Of 7324 patients, 24.5% were frail and 6.5% malnourished. Frail patients had significantly longer hospital stays (3.34 vs. 2.57 days, p < 0.001), extended operative times (178 vs. 165 min, p < 0.001), and higher rates of major complications (16.4% vs. 10.3%, p < 0.001) compared to non-frail patients. Malnourished patients also experienced higher major complication rates (30.7% vs. 11.6%, p < 0.001) and 30-day mortality (2.47% vs. 0.60%, p = 0.003). Preoperative albumin levels were the most predictive for mortality (AUC 0.72) and transfusion needs (AUC 0.72). Frailty and malnutrition significantly increase perioperative risks in patients undergoing minimally invasive RN. Preoperative assessments focusing on frailty and nutritional status may improve patient counseling, risk stratification, and help target preoperative interventions that may lead to improved perioperative outcomes.