Radical nephroureterectomy (RNU) with bladder cuff resection is the standard treatment for localized upper tract urothelial carcinoma (UTUC), but it carries a high risk of short-term postoperative complications, particularly in older and frail patients. Identifying a practical frailty screening tool is essential for optimizing preoperative care. The Geriatric 8 (G8) index is a validated tool for detecting frailty in older adults and has shown potential as a predictor of surgical outcomes. This study aimed to evaluate the utility of the G8 in predicting short-term postoperative complications in elderly patients undergoing RNU for UTUC.

This retrospective, single-center study included 200 patients aged ≥70 years who underwent RNU for UTUC between 2013 and 2022. The G8 includes eight items: age, BMI, food intake, weight loss, mobility, neuropsychological status, polypharmacy, and self-perceived health. Scores range from 0 to 17; patients were categorized as frail (G8 ≤14) or non-frail (G8 >14). Postoperative complications were graded using the Clavien-Dindo system: Grade I–II as minor, Grade III–V as major. The Mann–Whitney U test was used for continuous variables, and the chi-squared test for categorical variables including transfusion, fever, and mortality. Logistic regression identified independent predictors of complications.

Of the 200 patients, 91 (45.5%) were classified as frail. Compared with non-frail patients, the frail group had longer hospital stays (median 11 vs 9 days, p<0.001), higher rates of transfusion (43.9% vs 18.7%, p<0.001), minor complications (58.3% vs 35.2%, p<0.001), major complications (13.9% vs 3.3%, p<0.05), and 90-day mortality (4.6% vs 0%, p<0.05). Multivariate analysis showed that frailty was an independent predictor of both minor (OR=3.10, p<0.001) and major complications (OR=5.45, p<0.05).

Preoperative frailty, as assessed by the G8, independently predicts adverse short-term outcomes in elderly patients undergoing RNU for UTUC. Frailty, as identified by a G8 score ≤14, is associated with increased risks of transfusion, prolonged hospitalization, complications, and 90-day mortality. These findings highlight the importance of incorporating frailty assessment into preoperative evaluation to identify high-risk patients, guide perioperative management strategies, and potentially improve surgical outcomes in the geriatric population.