Frailty and malnutrition scores in predicting postoperative complications in minimally invasive prostatectomy for malignancy of the prostate.

Prostate cancer (PCa), the second most common cancer in men, is typically diagnosed between ages 65 and 74. When planning radical prostatectomy, patient frailty and nutritional status must be carefully evaluated. This study investigates the association between frailty, malnutritional status, and postprostatectomy complications in PCa patients. We analyzed the ACS-NSQIP prostatectomy series (2019-2022), focusing on minimally invasive procedures, including only malignant neoplasm diagnoses. The modified 5-index frailty (mFI-5) was calculated, where values of 2 or higher indicated frailty. Nutritional risk was assessed using a Nutritional Risk Index (NRI) of ≤ 97.5 and preoperative hypoalbuminemia (≤ 3.5) as indicators of malnutrition. Incomplete records were excluded, and remaining data were analyzed using R 4.3.3. The study included 21,067 patients. Compared to non-frail patients, frail individuals were significantly older and showed higher rates of diabetes, smoking, elevated BMI, and ASA scores > 2 (all p < 0.001). Frail patients also experienced longer hospital stays and operative times (p < 0.001), along with higher rates of renal insufficiency (p = 0.018), urinary infections (p = 0.001), systemic shock (p = 0.003), and overall complications (p = 0.002) compared to non-frail patients. Of the 9,932 patients evaluated for nutritional status, 342 met malnutrition criteria. Those identified by NRI criteria, experienced longer hospital stays and higher rates of myocardial infarction, and those identified by low albumin levels, showed increased length of stay (p = 0.044), major complications (p = 0.013), and rates of return to the operating room (p = 0.005), when compared to the normal cohort. Frailty and malnutrition are independent risk factors for postoperative complication in minimally invasive prostatectomy, highlighting the need for preoperative optimization.