The modified G8 screening tool to predict post-operative complications and survival after robot-assisted radical cystectomy – a pilot study

To evaluate whether the modified G8 (mG8) screening tool predicts severe postoperative complications and 90-day mortality in patients undergoing robot-assisted radical cystectomy (RARC). We performed a single centre retrospective cohort study of patients who underwent RARC with ileal conduit or orthotopic neobladder diversion between 2011 and 2020 at a tertiary centre. Preoperative frailty was assessed using the mG8 score. Severe complications were defined as Clavien–Dindo grade ≥ 3. Univariable and multivariable logistic regression analyses were performed to evaluate the association of the mG8 score with severe complications and 90-day mortality. A total of 155 patients were included. The median age was 69 years, and 49 patients (31.6%) had an impaired mG8 score (≥ 6). Severe complications occurred in 67 patients (43.2%), and 90-day mortality occurred in 10 patients (6.5%). In univariable analysis, an impaired mG8 score was significantly associated with severe complications (OR 2.94, 95% CI 1.46–5.93, p = 0.002). After adjusting for age group, the mG8 score remained an independent predictor (OR 2.65, 95% CI 1.29–5.45, p = 0.008). An impaired mG8 score was also associated with increased 90-day mortality (OR 5.72, 95% CI 1.46–22.81, p = 0.015). Age ≥ 76 years predicted higher mortality in univariable analysis but was not associated with severe complications in adjusted models. The mG8 screening tool is a promising predictor of major postoperative complications and 90-day mortality following RARC. Frailty, rather than chronological age or comorbidity burden, appears to better identify high-risk patients. Prospective multicentre studies are warranted to validate the role of the mG8 score in preoperative risk stratification for radical cystectomy.