Impact of frailty on adverse outcomes after radical cystectomy: a systematic review and meta-analysis

Objective Bladder cancer predominantly affects older adults, with approximately 70% of cases occurring in individuals aged ≥65 years, placing a substantial proportion of patients at increased risk of frailty and age-related comorbidities. However, the impact of frailty on the surgical outcomes of such patients remains unclear. The present systematic review examined the role of frailty in predicting major complications, mortality, readmission, and non-home discharge in patients undergoing radical cystectomy. Methods PubMed, Web of Science, Embase, and Scopus were searched up to May 10, 2025, for relevant studies. Random-effects meta-analysis of crude and adjusted data was conducted to compare outcomes between frail and non-frail patients. Results Sixteen studies with 55,811 patients were included. Analysis of crude data showed that risk of major complications (OR: 1.09 95% CI: 0.60, 1.98 I 2 = 84%), all complications (OR: 1.77 95% CI: 0.63, 4.95 I 2 = 0%), short-term mortality (<1 year) (OR: 2.23 95% CI: 0.63, 7.84 I 2 = 57%), long-term mortality (>1 year) (OR: 1.81 95% CI: 0.87, 3.80 I 2 = 71%), and readmission rates (OR: 1.55 95% CI: 0.51, 4.65 I 2 = 0%) did not differ significantly between frail and non-frail patients. However, meta-analysis of adjusted data showed increased risk of major complications (OR: 2.50 95% CI: 1.59, 3.95 I 2 = 20%), mortality (OR: 2.12 95% CI: 1.41, 3.18 I 2 = 88%), and non-home discharge (OR: 4.10 95% CI: 2.07, 8.13 I 2 = 40%) in frail patients as compared to non-frail patients. Conclusions Frailty could be a risk factor for adverse outcomes in patients undergoing radical cystectomy. Further robust studies reporting adjusted data are needed to supplement current conclusions. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251041804.