Surgical Risk Assessment Tools Research Articles

The association of hernia-specific and procedural risk factors with early complications in ventral hernia repair: ACHQC analysis

BackgroundMany surgical risk assessment tools emphasize patient-specific risk factors. Our objective was to use a hernia-specific database to assess risk factors of complications in ventral hernia repair (VHR) focusing on hernia-specific and procedural factors. MethodsThe ACHQC database was queried for elective VHR in adults from 2012 to 2023. Primary outcome was overall 30-day complications. Multivariable logistic regression was used for analysis. Results41,526 VHR were included. The rate of 30-day complications was 18%, surgical site infection 3%, surgical site occurrence requiring procedural intervention 4%, readmission 4%, reoperation 2%, and mortality 0.2%. Multivariable analysis demonstrated that BMI, ASA, frailty, COPD, anticoagulants, defect width, incisional and recurrent hernias, presence of stoma or prior mesh, prior abdominal wall infection, non-clean wound, operative time, open approach and myofascial release were associated with 30-day complications (OR ​= ​1.01–1.66). Preoperative chlorhexidine, bowel preparation and fascial closure were associated with lower complication risk (OR ​= ​0.70–0.89). ConclusionHernia and procedural risk factors are associated with early complications following elective VHR. These factors need to be included in surgical risk assessment tools, to supplement patient-specific factors.

Sarcopenia 'made simple' and outcomes from emergency laparotomy.

Emergency Laparotomy (EL) is recognized as high-risk surgery with high mortality. Established surgical risk assessment tools (NELA Risk Prediction Calculator, P-POSSUM, ACS-NSQIP) are accurate predictors of morbidity and mortality. However, their multicomponent complexity limits their use in practice. Sarcopenia is associated with poorer surgical outcomes. This study tests for an association between a simple measure of radiological sarcopenia and mortality in EL patients in an Australian cohort. A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016-2017. All patients had a contemporaneous abdomino-pelvic CT scan. Radiological sarcopenia was measured as the ratio of total psoas muscle area (PM) to L3 vertebral body cross sectional area (PM:L3). Patients were followed up to 12 months. Primary outcomes were 30-, 90- and 365-day mortality. The mean 30-day mortality predictions for NELA, P-POSSUM and ACS-NSQIP were 11.36%, 17.28% and 11.30% respectively. PM:L3 ratio was associated with 30-, 90- and 365-day mortality (P < 0.001) and sex (P < 0.001) and negatively correlated with age (r=-0.4612; P < 0.001). Radiological sarcopenia had a weak negative correlation with NELA (r=-0.2737; P < 0.001), P-POSSUM (r=-0.1880; P < 0.001) and ACS-NSQIP (r=-0.2351; P < 0.001). The latter three metrics were significantly correlated (r > 0.5696; P < 0.001). Radiological sarcopenia (CT-assessed PM:L3) is a significant predictor of mortality in EL patients in Australia. The results of this study suggest that radiological sarcopenia is equivalent to established risk assessment tools. The more timely and easily accessible CT-assessed PM:L3 metric is potentially automatable and may have significant utility in clinical practice.

Evaluation of Post-OP Complications using Risk Assessment Tool; Attitude of Surgeons

Objective: Current study was designed to assess the attitude of surgeons towards the use of surgical risk assessment tools in Sargodha. Method: This study was of descriptive crossectional nature. It was a survey based study conducted in a 4 tertiary care hospitals of Sargodha. Data of 30 surgeons was collected using a questionnaire. Frequencies and percentages were calculated to interpret results. Results: The usage of online risk calculator was never used by majority of surgeons (83.33%). Risk assessment is always based on prior experience (76.67%). Evaluation of risk assessment based on existing literature is always practiced by 53.33% surgeons. Conclusion: majority of surgeons are not using risk assessment calculator in surgical settings. They are focusing on prior experience based assessment of post-op complications. The briefing time given by surgeon to the patients while communicating their risk assessment is very less which should be maintained by the hospital management. Keywords: Risk Assessment, Post-op Complications, Surgeons, Infections

Attitudes about use of preoperative risk assessment tools: a survey of surgeons and surgical residents in an academic health system

BackgroundFormal surgical risk assessment tools have been developed to predict risk of adverse postoperative patient outcomes. Such tools accurately predict common postoperative complications, inform patients and providers of likely perioperative outcomes, guide decision making, and improve patient care. However, these are underutilized. We studied the attitudes towards and techniques of how surgeons preoperatively assess risk.MethodsSurgeons at a large academic tertiary referral hospital and affiliate community hospitals were emailed a 16-question survey via REDCap (Research Electronic Data Capture) between 8/2019-6/2020. Reminder emails were sent once weekly for three weeks. All completed surveys by surgical residents and attendings were included; incomplete surveys were excluded. Surveys were analyzed using descriptive statistics (frequency distributions and percentages for categorical variables, means, and standard deviations for continuous variables), and Fisher’s exact test and unpaired t-tests comparing responses by surgical attendings vs. residents.ResultsA total of 108 surgical faculty, 95 surgical residents, and 58 affiliate surgeons were emailed the survey. Overall response rates were 50.0% for faculty surgeons, 47.4% for residents, and 36.2% for affiliate surgeons. Only 20.8% of surgeons used risk calculators most or all of the time. Attending surgeons were more likely to use prior experience and current literature while residents used risk calculators more frequently. Risk assessment tools were more likely to be used when predicting major complications and death in older patients with significant risk factors. Greatest barriers for use of risk assessment tools included time, inaccessibility, and trust in accuracy.ConclusionsA small percentage of surgeons use surgical risk calculators as part of their routine practice. Time, inaccessibility, and trust in accuracy were the most significant barriers to use.

Surgical risk assessment for super-elderly patients.

Super-elderly patients are often frail and the decision on surgical indications remains a difficult issue. The purpose of this study was to provide a certain preoperative surgical risk assessment tool for super-elderly people. We selected 112 individuals who were super-elderly patients aged >90 years who had surgeries under general anesthesia in our department. Based on the quality of the postoperative outcome of each case, we categorized these patients into two groups: good and poor groups. We evaluated the fundamental examination items, such as American Society of Anesthesiologists physical status, skeletal muscle mass index and so on, and a couple of the well-known risk score systems represented by Estimation of Physiology Ability and Surgical Stress. A total of 85 of the 112 patients belonged to the good group and the rest belonged to the poor group. The quality of postoperative outcome is well characterized by Estimation of Physiology Ability and Surgical Stress (P=0.001). Receiver operating characteristic analysis of Estimation of Physiology Ability and Surgical Stress for the quality of postoperative outcome shows sensitivity of 0.83 and specificity of 0.61. Multivariate logistic regression analysis showed that skeletal muscle mass index and American Society of Anesthesiologists physical status are prominent as the risk determinants affecting the quality of postoperative outcome. A scoring system based on the skeletal muscle mass index, which is a good index of sarcopenia, and American Society of Anesthesiologists physical status, named the "SAP score" has the following characteristics. P-value <0.001, sensitivity 0.76 and specificity 0.91. Informed consent based on the risk score might be able to reduce the regrettable situation where it would have been better to have had surgery or not to have had surgery. Geriatr Gerontol Int 2022; 22: 271-277.

Analysis of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) Database to Identify Factors Associated with Postoperative Mortality After Elective Non-cardiac Surgery

Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator, have been devised to predict postoperative mortality. However, the role of individual factors on mortality is unclear. We sought to identify patient characteristics from the database that were associated with postoperative mortality in patients undergoing elective, non-cardiac surgery. Data from the ACS NSQIP® database at a tertiary care academic medical center was analyzed from January 2011 to September 2016. Relevant patient-related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality. A multivariable logistic regression model was then used to assess the adjusted effect of each potential risk factor on the outcome. A total of 5254 database patient records were identified and among the analyzed variables, American Society of Anesthesiologists (ASA) physical status III and IV (odds ratio and 95%CI: 16.75 [2.29, 122.69]), poor preoperative functional health status (odds ratio and 95%CI: 38.52 [2.46, 604.12]), and low serum albumin (odds ratio and 95%CI: 3.76 [1.35, 10.44]) were significant predictors of 30-day postoperative mortality. In a comprehensive analysis of the ACS NSQIP®database, spreading across multiple surgical specialties, we found an association between ASA physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery.

The Psoas Muscle Index Is Associated with Prognosis in Elderly Patients Undergoing Cardiovascular Surgery

BackgroundSarcopenia is associated with poor outcomes in elderly patients. However, current surgical risk assessment tools for cardiovascular surgery do not include the impact of sarcopenia.ObjectivesThis study aimed to assess whether the psoas muscle index, a numerical score used to assess sarcopenia, is associated with outcomes in elderly patients undergoing cardiovascular surgery.MethodsThis nested case-control study evaluated patients aged ≥ 75 years who underwent elective cardiovascular surgery and were admitted to the intensive care unit at Jichi Medical University, Saitama Medical Center between January 1, 2016 and March 31, 2017. The case group (poor outcomes) included patients who either died or were transferred to a rehabilitation facility postoperatively. The control group (good outcomes) included patients who were discharged postoperatively. Clinical factors likely to affect patient outcomes were assessed, and the characteristics of the two outcome groups were compared using logistic regression analysis.ResultsIn total, 183 patients were evaluated; among them, 137 and 46 patients were categorized to the good and poor outcome groups, respectively. The psoas muscle index was significantly associated with outcome (odds ratio: 0.25; 95% confidence interval: 0.14 – 0.43; P < 0.001). A psoas muscle index cut-off of 3.24 had a specificity, sensitivity, positive predictive value, and negative predictive value of 0.86, 0.63, 0.58, and 0.87, respectively, for predicting worse outcome at discharge.ConclusionsThe psoas muscle index was strongly associated with discharge to home in patients aged ≥ 75 years who underwent elective cardiovascular surgery. This finding suggests that the psoas muscle index might be useful in identifying the eligibility of older patients for cardiovascular surgery.

The value of screening for cognition, depression, and frailty in patients referred for TAVI.

Background: Current surgical risk assessment tools fall short of appreciating geriatric risk factors including cognitive deficits, depressive, and frailty symptoms that may worsen outcomes post-transcatheter aortic valve implantation (TAVI). This study hypothesized that a screening tool, SMARTIE, would improve detection of these risks pre-TAVI, and thus be predictive of postoperative delirium (POD) and 30-day mortality post-TAVI.Design: Prospective observational cohort study, using a historical cohort for comparison.Participants: A total of 234 patients (age: 82.2±6.7 years, 59.4% male) were included. Half were screened using SMARTIE.Methods: The SMARTIE cohort was assessed for cognitive deficits and depressive symptoms using the Mini-Cog test and PHQ-2, respectively. Measures of frailty included activities of daily living inventory, the Timed Up and Go test and grip strength. For the pre-SMARTIE cohort, we extracted cognitive deficits, depression and frailty symptoms from clinic charts. The incidence of POD and 30-day mortality were recorded. Bivariate chi-square analysis or t-tests were used to report associations between SMARTIE and pre-SMARTIE groups. Multivariable logistic regression models were employed to identify independent predictors of POD and 30-day mortality.Results: More patients were identified with cognitive deficits (χ2=11.73, p=0.001), depressive symptoms (χ2=8.15, p=0.004), and physical frailty (χ2=5.73, p=0.017) using SMARTIE. Cognitive deficits were an independent predictor of POD (OR: 8.4, p<0.01) and 30-day mortality (OR: 4.04, p=0.03).Conclusion: This study emphasized the value of screening for geriatric risk factors prior to TAVI by demonstrating that screening increased identification of at-risk patients. It also confirmed findings that cognitive deficits are predictive of POD and mortality following TAVI.

Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery.

Purpose: To determine the association between frailty and postoperative complications in elderly Chinese patients and to determine whether addition of frailty assessment improves the predictive ability of the American Society of Anesthesiologists (ASA) score, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Estimation of Physiologic Ability and Surgical Stress (E-PASS) score.Patients and methods: A prospective cohort study was conducted in a tertiary hospital. Elderly patients undergoing major thoracic or abdominal surgery were included. Frailty phenotype and ASA, POSSUM, and E-PASS scores were assessed. Demographic, preoperative, and surgical variables were extracted from medical records. Primary outcome measure was in-hospital Clavien-Dindo ≥ grade II complications. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves were used to explore the predictive ability of frailty.Results: Prevalence of frailty was 26.12%. Significant differences were observed between the frail and non-frail groups with respect to age, Activities of Daily Living, Charlson Comorbidity Index, respiratory function, presence of malignancy, serum albumin, prealbumin, and hemoglobin levels (P<0.05). ASA, POSSUM, and E-PASS scores were higher in the frail group. After adjusting for all covariates, frailty was significantly associated with postoperative complications in hospital [odds ratio: 16.59, 95% CI: 4.56–60.40, P<0.001]. The area under the curve (AUC) for frailty was 0.762 (95% CI: 0.703–0.814). The AUC for ASA, POSSUM, and E-PASS for prediction of complications was 0.751 (95% CI: 0.692–0.804), 0.762 (95% CI: 0.704–0.814), and 0.824 (95% CI: 0.771–0.870), respectively. Addition of frailty assessment increased the AUC to 0.858 (95% CI: 0.808–0.899), 0.842 (95% CI: 0.790–0.885), and 0.854 (95% CI: 0.803–0.896), respectively.Conclusion: Frailty is an effective predictor of postoperative complications in elderly Chinese patients undergoing major thoracic and abdominal surgery. Frailty assessment can improve the predictive ability of current surgical risk assessment tools. Frailty phenotype should be considered perioperatively. Frailty assessment could also expand the scope for nurses to evaluate patients for safety management.

Pediatric Surgical Risk Assessment Tools: A Systematic Review

BackgroundPediatric surgical risk assessment tools use patient- and procedure-specific variables to predict postoperative complications. These tools assist clinicians in preoperative counseling and surgical decision-making. The objective of this systematic literature review was to compile and compare existing pediatric surgical risk tools that are broadly applicable across pediatric surgical specialties. MethodsA systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Relevant publications were identified and screened based on predefined eligibility criteria: (1) a preoperative risk assessment tool predicting postoperative complications or mortality, (2) applicable across various surgical specialties, and (3) pertinent to the pediatric population. Studies with specialty- or procedure-specific risk scores and validation studies were excluded. Included articles were assessed for quality and risk of bias by using the Newcastle–Ottawa Scale. ResultsFour studies met inclusion criteria. Risk factors were evaluated across the models as proxies for operative suitability of patients before surgery. Risk factors common to all studies were the presence of cardiovascular or neurological diseases and history of prematurity. Three of the four included studies defined most risk factors in binary terms, whereas one study used a scale of severity of organ system disease when defining preoperative risk. Generated risk score models provided good to strong concordance with inpatient mortality or postoperative complications, with c-statistic values ranging from 0.77 to 0.98. ConclusionsEach study reported an assessment of a novel, generally applicable pediatric surgical risk assessment tool for risk-stratifying children preoperatively for complications that rise after surgery. More studies are needed to assess generalizability in all populations and procedures.

Eye of the beholder: Risk calculators and barriers to adoption in surgical trainees

Accurate risk assessment before surgery is complex and hampered by behavioral factors. Underutilized risk-based decision-support tools may counteract these barriers. The purpose of this study was to identify perceptions of and barriers to the use of surgical risk-assessment tools and assess the importance of data framing as a barrier to adoption in surgical trainees. We distributed a survey and risk assessment activity to surgical trainees at four training institutions. The primary outcomes of this study were descriptive risk assessment practices currently performed by residents, identifiable influences and obstacles to adoption, and the variability of preference sets when comparing modified System Usability Scores of a current risk calculator to a purpose-built calculator revision. Risk calculator comparison responses were compared with simple and multivariable regression to identify predictors for preferentiality. We collected responses from 124 surgical residents (39% response rate). Participants endorsed familiarity with direct verbal communication (100%), sketch diagrams (87%), and brochures (59%). The most contemporary risk communication frameworks, such as best-worst case scenario framing (38%), case-specific risk calculators (43%), and all-procedure calculators (52%) were the least familiar. Usage favored traditional models of communication with only 26% of residents regularly using a strategy other than direct verbal discussion or anatomic sketch diagrams. Barriers limiting routine use included lack of electronic and clinical workflow integration. The mean modified System Usability Scores domain scores were widely dispersed for all domains, and no domain demonstrated one calculator's superiority over another. Risk assessment tools are underutilized by trainees. Of importance, preference sets of clinicians appear to be unpredictable and may benefit more from a customizable, bespoke approach.

ACSNSQIP Risk Calculator in Indian Patients Undergoing Surgery for Head and Neck Cancers: Is It Valid?

Pre-operative assessment is vital to determine patient-specific risks and minimize them in order to optimize surgical outcomes. The American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP) Surgical Risk Calculator is the most comprehensive surgical risk assessment tool available. We performed this study to determine the validity of ACSNSQIP calculator when used to predict surgical complications in a cohort of patients with head and neck cancer treated in an Indian tertiary care center. Retrospective data was collected for 150 patients with head and neck cancer who were operated in the Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, in the year 2016. The predicted outcome data was compared with actual documented outcome data for the variables mentioned. Brier's score was used to estimate the predictive value of the risk assessment generated. Pearson's r coefficient was utilized to validate the prediction of length of hospital stay. Brier's score for the entire calculator was 0.32 (not significant). Additionally, when the score was determined for individual parameters (surgical site infection, pneumonia, etc.), none were significant. Pearson's r value for length of stay was also not significant (p = .632). The ACSNSQIP risk assessment tool did not accurately reflect surgical outcomes in our cohort of Indian patients. Although it is the most comprehensive tool available at present, modifications that may improve accuracy are allowing for input of multiple procedure codes, risk stratifying for previous radiation or surgery, and better risk assessment for microvascular flap reconstruction.

Frailty and one-year mortality in major intra-abdominal operations

BackgroundFrailty is an objective measurement capable of preoperatively identifying patients with increased risk of 30-d morbidity and mortality, though less is known about its utility beyond that timeframe. We hypothesized that preoperative frailty is associated with an increased risk of 1-y mortality in patients undergoing major intra-abdominal surgery. Materials and methodsDemographics, laboratory values, and traditional surgical risk assessments (American Society of Anesthesiologists scale, Eastern Cooperative Oncology Group Performance Status, Charlson Comorbidity Index) were collected prospectively. Preoperative frailty was evaluated using Fried criteria. Postoperative complications were defined by Clavien–Dindo Classification. One-year mortality data were gathered from phone calls, medical records, and the National Death Index. ResultsThis study included 189 patients with a mean age of 62 years. Of the total, 59.8% were male and 71.4% were Caucasian. At enrollment, 139 (73.5%) patients were considered “not frail”, whereas 50 (26.5%) were considered “intermediately frail” or “frail”. A total of 73 (38.6%) patients experienced a 30-d postoperative complication. At 1 y, 15 (7.9%) patients had died, 5 (3.6%) not frail and 10 (20.0%) intermediately frail/frail patients. Postoperative mortality occurred <30 d, between 31-100 d, and >100 d in 3, 4, and 8 patients, respectively. Malignant neoplasm was documented as the underlying cause of death in 12 patients. All 30-d mortalities occurred in frail patients who had a postoperative complication. ConclusionsFrailty status is predictive of 1-y postoperative mortality. The Fried Frailty Criteria has the potential to more accurately evaluate surgical patients' mortality risk beyond the immediate postoperative period, particularly when considered collectively with traditional surgical risk assessment tools.

Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study

BackgroundThe evaluation of surgical risk is crucial in elderly patients. At present, there is little evidence of the usefulness of comprehensive geriatric assessment (CGA) as a part of the overall assessment of surgical elderly patients. MethodsWe verified whether CGA associated with established surgical risk assessment tools is able to improve the prediction of postoperative morbidity and mortality in 377 elderly patients undergoing elective surgery. ResultsOverall mortality and morbidity were 2.4% and 19.9%, respectively. Multivariate analysis showed that impaired cognitive function (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.15 to 4.22; P < .02) and higher Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (OR, 1.11; 95% CI, 1.00 to 1.23; P < .04) are predictive of mortality. Higher comorbidity is predictive of morbidity (OR, 2.12; 95% CI, 1.06 to 4.22; P < .03) and higher American Society of Anesthesiologists (OR, 2.18; 95% CI, 1.31 to 3.63; P < .001) and National Confidential Enquiry into Patient Outcome of Death score (OR, 2.03; 95% CI, 1.03 to 4.00; P < .04). ConclusionsIn elective surgical elderly patients, the morbidity and mortality are low. The use of CGA improves the identification of elderly patients at higher risk of adverse events, independent of the surgical prognostic indices.

Frailty in cardiothoracic surgery: systematic review of the literature.

A preoperative surgical risk analysis is necessary and important for predicting clinical and surgical outcomes in a clinical setting. Various tools for evaluating the patient characteristics in order to forecast perioperative clinical outcomes have previously been described; however, an objective and precise preoperative risk assessment has not yet been established. In the last decade, the concept of frailty, which is a geriatric assessment that identifies disabilities and weaknesses in patients, has been used in order to predict clinical mortality and morbidity following invasive surgical interventions because the prevalence of elderly patients among those undergoing surgical interventions is increasing. Since there is currently no single generally accepted clinical definition of frailty, many clinical modalities are needed to evaluate the patients' geriatric activity of daily living. Quantifying the quality of frailty is an evolving challenge for predicting surgical risks preoperatively. In recent years, with the development of transcatheter aortic valve implantation (TAVI), this newly definitive preoperative surgical risk assessment tool, frailty, has become more important and is attracting interest in cardiothoracic surgical settings. Thus, this review summarized current consideration on the preoperative risk analysis by frailty as well as future perspectives and the potential of an ideal frailty risk assessment in cardiothoracic surgery, including the management of elderly patients and high-risk aortic valve stenosis by TAVI.

The Use of Frailty as a Surgical Risk Assessment Tool in Elderly Patients

With the continued aging of the population, a rising proportion of surgical procedures will be performed in elderly patients. Current surgical decision-making tools rely on subjective judgments and were developed without special geriatric considerations. As a result, they have certain inadequacies that limit their utility in this population. Frailty, described for decades by the medical geriatric community, has just recently begun to be investigated as a surgical risk assessment tool. Identifying the frailty phenotype has been shown by multiple investigators to reliably predict which patients are at increased risk of adverse peri-operative outcomes. Perhaps, most importantly, it is a tool that can potentially discriminate among the elderly, identifying those that warrant heightened concern, "pre-habilitation", or special postoperative attention from those at no increased risk compared to the general population. Alternatively, some patients may be identified as “too frail” to undergo surgery, and alternative nonsurgical treatment options may be considered.

517 INITIAL EXPERIENCE ASSESSING PRE-OPERATIVE FRAILTY WITH PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CANCER

INTRODUCTION AND OBJECTIVES: Radical cystectomy for the treatment of bladder cancer is associated with significant postoperative morbidity and mortality, yet pre-operative risk stratification is relatively subjective. The decision to operate or not operate on a patient relies on very little objective/quantifiable data. Recently, the concept of frailty as a surgical risk assessment tool to predict postoperative outcomes has been introduced and is beginning to be examined clinically. In this initial study, we prospectively evaluated bladder cancer patients’ pre-operative frailty and attempted to correlate these presurgical measures with post-operative outcomes. METHODS: Patients undergoing radical cystectomy were voluntarily enrolled in this study after IRB approval was obtained. Preoperative frailty data was collected on the following five domains: shrinking, weakness, exhaustion, low physical activity, and walking speed. Patients were classified as either non-frail, intermediately frail, or frail, according to previously published objective standards. 30-day postoperative outcomes were recorded. RESULTS: During our initial 4-month study period, we collected data on 23 patients undergoing radical cystectomy. On average, data collection required only 4-6 minutes. Of this small cohort, 17 (73.9%) patients were white, and13 (56.5%) patients were males. Mean age was 65.83 years (range 43-84). Based on the five frailty domains, there were 12 (52.2%) non-frail, 10 (43.5%) intermediately frail, and 1 (4.3%) frail patients, respectively. Overall, there were 17 total complications: 12 (70.6%) Grade I/II, 3 (17.7%) Grade IIIa, 1 (5.9%) Grade IIIb, and 1 (5.9%) Grade V. There was a statistically significant relationship between increasing frailty and decreasing serum albumin (p 0.04). However, there was not a statistically significant association between increasing frailty and patients’ post-operative length of stay (p 0.2) and incidence of post-operative complications (p 0.4). CONCLUSIONS: Our initial experience with assessing preoperative frailty in patients undergoing radical cystectomy demonstrates that is easy and efficient to do in a busy clinical setting. Although our initial data does not show a correlation with post-operative outcomes, this is most likely due to our initial small sample size. Nevertheless, there is a statistically significant inverse relationship between frailty and serum albumin, suggesting that with a larger cohort frailty may predict post-operative outcomes. Further prospective evaluation is warranted and ongoing.