Utility of Frailty Assessment in Urologic Stone Surgery: A Review of the Literature

Introduction and Objective: As life expectancy continues to rise, the prevalence of frailty is also increasing. The idea of frailty and its effect on the operative patient has been previously studied, but not regularly incorporated into routine practice. We present a review on frailty metrics in the literature, validated assessment methods, and simplified screening tools to better predict and optimize patient outcomes. Methods: An online PubMed search was conducted by three authors (T.A., T.G.R.B., M.M.) for overall frailty, frailty assessment, and preoperative risk assessment. Only English publications were included in the analysis. Full-text analysis was then conducted by all three authors to validate the data. Results: An abundance of literature was found on frailty. Even though some methods are validated as extremely effective for assessing frailty, they may be time-consuming and require a specialist. Various quick screening methods are also presented, many already validated, and should be utilized by urologists more regularly. Conclusions: Multiple studies demonstrate the relationship between frailty and surgical patients' outcome. Many quick, office-based, validated tools to screen for frailty are described, and should be incorporated into our practice in appropriate patients. Future research is now focused on the concept of “prehabilitation” to improve patient frailty status in the preoperative setting, and consequently operative outcomes.