The modified 5-item frailty index (mFI-5) is increasingly recognized as a valuable tool for predicting postoperative risks, yet its role in urology, specifically in percutaneous nephrolithotomy (PCNL), remains underexplored. This study aimed to assess whether the mFI-5 could effectively identify patients at higher risk of complications following PCNL, a common procedure for kidney stone removal. Researchers analyzed data from 320 PCNL patients between 2015 and 2021, focusing on demographics, health conditions, operative details, and outcomes. Frailty was scored based on the presence of five health factors: congestive heart failure, diabetes, chronic obstructive pulmonary disease, functional dependence, and hypertension requiring medication. Patients were grouped as not frail (mFI-5=0), intermediate (mFI-5=1), and severely frail (mFI-5>2).
Results showed that frail patients, particularly those classified as intermediate or severely frail, faced higher risks of postoperative complications, including sepsis, significant blood loss, and the need for ICU care. Frail patients also tended to be older and had higher scores on the American Society of Anesthesiologists and Charlson comorbidity indices, indicating more severe health profiles. Length of hospital stay was notably longer for frail patients, who were also more likely to require reoperation or experience unplanned readmission within 30 days post-surgery. While frailty did not correlate with factors like stone size or location, it provided a clear indication of vulnerability to complications.
These findings suggest that preoperative mFI-5 assessments can be instrumental in identifying PCNL patients at greater risk, aiding in surgical planning and patient counseling. With mFI-5, clinicians can more accurately anticipate extended hospital stays or complications, ensuring patients receive more tailored care and informed guidance on expected recovery.
