Frailty scoring systems in urological surgery: Current status and future perspectives

Frailty refers to a state of increased vulnerability and is recognised to be multifactorial. It is associated with a higher likelihood for functional dependency and a reduced life expectancy. In the surgical setting, frailty has attracted increased attention in regard to how it can impact post-operative outcomes. Many research groups have explored ways to translate frailty into a clinical marker and represent it as a quantifiable measurement. To this end, there now exist a plethora of tools (over 50 tools) available that have been applied in a clinical and/or research setting across nearly all medical and surgical specialities. However, the large number of tools can make it challenging for clinicians to know which one to adopt. This article provides an overview of the commonly used tools in urological surgery. Most tools have been studied in the context of urological cancer surgery and consistently show that frailty is associated with poorer outcomes. Of note, none of the systems described were developed exclusively for purely urological studies. Many of the abovementioned systems require a face-to-face assessment and therefore preclude retrospective data collection. Frail patients may not therefore be eligible on account of either one of these and it may account for why research in this field is lacking. Important outcomes such as the discharge location and how ADLs have changed are also challenging to collect retrospectively. Further research should focus on developing a frailty scoring system that is customised for urological surgeries.