# Impact of frailty on adverse outcomes after radical cystectomy: a systematic review and meta-analysis

## TL;DR

This study finds that frailty may increase the risk of complications and poor outcomes after bladder cancer surgery, especially when adjusted for other factors.

## Contribution

The study is the first to systematically review and meta-analyze the impact of frailty on outcomes after radical cystectomy using both crude and adjusted data.

## Key findings

- Frail patients had higher adjusted risks of major complications, mortality, and non-home discharge after surgery.
- Crude data showed no significant differences in most outcomes between frail and non-frail patients.
- Adjusted data highlights the importance of accounting for confounding factors when assessing frailty's impact.

## Abstract

Bladder cancer predominantly affects older adults, with approximately 70% of cases occurring in individuals aged ≥65 years, placing a substantial proportion of patients at increased risk of frailty and age-related comorbidities. However, the impact of frailty on the surgical outcomes of such patients remains unclear. The present systematic review examined the role of frailty in predicting major complications, mortality, readmission, and non-home discharge in patients undergoing radical cystectomy.

PubMed, Web of Science, Embase, and Scopus were searched up to May 10, 2025, for relevant studies. Random-effects meta-analysis of crude and adjusted data was conducted to compare outcomes between frail and non-frail patients.

Sixteen studies with 55,811 patients were included. Analysis of crude data showed that risk of major complications (OR: 1.09 95% CI: 0.60, 1.98 I2 = 84%), all complications (OR: 1.77 95% CI: 0.63, 4.95 I2 = 0%), short-term mortality (<1 year) (OR: 2.23 95% CI: 0.63, 7.84 I2 = 57%), long-term mortality (>1 year) (OR: 1.81 95% CI: 0.87, 3.80 I2 = 71%), and readmission rates (OR: 1.55 95% CI: 0.51, 4.65 I2 = 0%) did not differ significantly between frail and non-frail patients. However, meta-analysis of adjusted data showed increased risk of major complications (OR: 2.50 95% CI: 1.59, 3.95 I2 = 20%), mortality (OR: 2.12 95% CI: 1.41, 3.18 I2 = 88%), and non-home discharge (OR: 4.10 95% CI: 2.07, 8.13 I2 = 40%) in frail patients as compared to non-frail patients.

Frailty could be a risk factor for adverse outcomes in patients undergoing radical cystectomy. Further robust studies reporting adjusted data are needed to supplement current conclusions.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251041804.