Robotic-assisted radical prostatectomy is pushing the boundaries: a national survey of frailty using the national surgical quality improvement program

BACKGROUND: Robotic-assisted radical prostatectomy (RARP) has been found to be comparable and, in some cases, favorable to open surgical approaches, while being used in a frailer population. OBJECTIVES: We aimed to illustrate the trend in population frailty and compare morbidity and mortality postoperatively in patients who underwent RARP. DESIGN AND METHODS: The National Surgical Quality Improvement Program data set was used to select patients who underwent RARP between the years 2011–2019. Age, frailty indicators, surgical characteristics, and perioperative morbidity and mortality were compared between the years 2011–2019 using the chi-square test (χ(2)) for categorical variables and the one-way analysis of variance (ANOVA) for continuous variables. RESULTS: Our patient population consisted of 66,683 patients who underwent RARP. There was an increase in mean age and frailty indicated by an increase in 5-item frailty score ⩾2, metabolic syndrome index = 3, and American Society of Anesthesiologists’ (ASA) class ⩾3 between the years 2011–2019 (p < 0.001). Whereas the rate of mortality and morbidity, indicated by postoperative Clavien–Dindo grade ⩾4 and major morbidity, remained the same over the same period (p > 0.264). Furthermore, operative time and length of stay decreased over the same period (p < 0.001). CONCLUSION: RARP is being performed on more frail patients, with no added morbidity or mortality.