{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:09:33Z","timestamp":1788394173338,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008363","name":"Danish Cancer Society","doi-asserted-by":"publisher","award":["R325-A18869"],"award-info":[{"award-number":["R325-A18869"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"award":["R325-A18869"],"award-info":[{"award-number":["R325-A18869"]}],"id":[{"id":"https:\/\/ror.org\/03ytt7k16","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is associated with high morbidity. Frailty is an important determinant of surgical outcomes; however, its association with the composite outcome Days Alive and Out of Hospital (DAOH) has not been examined following RC. We assessed the impact of preoperative frailty on 90-day DAOH in older patients undergoing RC for MIBC. Methods: We conducted a retrospective cohort study including 408 consecutive patients aged \u226565 years undergoing RC at a tertiary referral center between 2018 and 2023. Frailty was assessed using the record-based Multidimensional Prognostic Index (r-MPI), classifying patients as non-frail (MPI1), moderately frail (MPI2), or severely frail (MPI3). The primary outcome was 90-day DAOH; secondary outcomes included length of stay (LOS), postoperative complications, delirium, and mortality. DAOH was dichotomized at the cohort median. Associations with low DAOH were analyzed using modified Poisson regression with robust variance estimation. Results: Median 90-day DAOH decreased progressively with increasing frailty: MPI1: 81 days (IQR 76\u201383), MPI2: 73 days (IQR 62\u201380), MPI3: 67 days (IQR 52\u201376); p &lt; 0.01. In multivariable analysis, frailty was independently associated with low DAOH (MPI2: RR 2.46, 95% CI 1.94\u20133.11; MPI3: RR 3.37, 95% CI 2.55\u20134.46), whereas age and comorbidity were not. Increasing frailty was consistently linked to worse postoperative outcomes, including longer LOS, higher complication burden and severity, and more frequent delirium. Ninety-day postoperative complication-related mortality increased markedly with frailty (MPI1: 1.6%, MPI2: 11.9%, MPI3: 12.1%; p &lt; 0.01). Conclusions: Preoperative frailty is a strong independent predictor of low 90-day DAOH and adverse postoperative outcomes following RC in older patients.<\/jats:p>","DOI":"10.3390\/jcm15114057","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T01:45:08Z","timestamp":1779673508000},"page":"4057","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative Frailty Assessed by the Record-Based Multidimensional Prognostic Index Predicts 90-Day Days Alive and out of Hospital Following Radical Cystectomy for Bladder Cancer: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4112-1626","authenticated-orcid":false,"given":"Katharina","family":"Skovhus","sequence":"first","affiliation":[{"name":"Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark"},{"name":"Department of Geriatric Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark"},{"name":"Department of Geriatric Medicine, Regional Hospital Randers, 8930 Randers, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kristensen","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Regional Hospital Randers, 8930 Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5894-1611","authenticated-orcid":false,"given":"Danny Bech","family":"Sindberg","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Regional Hospital Randers, 8930 Randers, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"\u00d8rum","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bente Thoft","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5365-7335","authenticated-orcid":false,"given":"Merete","family":"Gregersen","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pernille Skjold","family":"Kingo","sequence":"additional","affiliation":[{"name":"Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/2090598X.2020.1841538","article-title":"Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: A systematic review","volume":"19","author":"Ornaghi","year":"2020","journal-title":"Arab. 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