Preoperative 5-Factor Frailty Index and Clavien–Dindo Grade ≥ II Complications Following Open Radical Nephrectomy: A Prospective Single-Center Cohort Study

Background/Objective: Preoperative frailty assessment before open radical nephrectomy for renal cell carcinoma (RCC) is underused, and prospective data on the 5-Factor Frailty Index (5-IFi) are limited. We examined the association between the preoperative 5-IFi score and postoperative complications at a private tertiary center in Khyber Pakhtunkhwa, Pakistan. Methods: In this prospective cohort study, 30 adults with suspected or confirmed RCC scheduled for elective open radical nephrectomy were enrolled after ethics approval. The 5-IFi was scored preoperatively from records and medication lists. The primary outcome was any Clavien–Dindo grade ≥ II complication during the index hospitalization; secondary outcomes were length of stay and 30-day unplanned readmission. Groups were compared using Mann–Whitney U and Fisher’s exact tests. Associations were estimated by Firth penalized logistic regression with profile-likelihood confidence intervals (CIs) and receiver operating characteristic (ROC) analysis with bootstrapped CIs; adjusted models were exploratory given the sample size. Results: Fourteen patients (46.7%) developed a grade ≥ II complication, all grade II; nine (30.0%) were frail (5-IFi ≥ 2). The 5-IFi score was the only baseline variable significantly associated with the outcome (median 1.5 vs. 1.0; p = 0.030). Each 1-point increase was associated with higher odds (unadjusted OR 2.35, 95% CI 1.16–6.80; adjusted for age and creatinine, OR 2.10, 95% CI 1.00–5.91). Discrimination was moderate but imprecise (AUC 0.72, 95% CI 0.53–0.88). At the ≥2 threshold, frail patients had a higher complication rate than non-frail/pre-frail patients (77.8% vs. 33.3%; Fisher’s exact p = 0.046; exact OR 6.5, 95% CI 0.92–80.65), with sensitivity 50.0% and specificity 87.5%; length of stay was marginally longer in frail patients (p = 0.035). No grade ≥ III complications or deaths occurred. Conclusions: In this small single-center cohort, a higher 5-IFi score was associated with grade ≥ II complications, consistent after limited adjustment. Given the small sample, imprecise estimates, and exclusively grade II events, these findings are preliminary and hypothesis-generating. Multicenter validation is required before the 5-IFi can guide preoperative risk stratification or prehabilitation triage.