Michel J, et al. - A total of 9,459 adults (age ≥18) in the Nationwide Readmission Database who underwent radical cystectomy in 2014 for bladder cancer were recognized by the experts in order to assess the influence of frailty on adverse perioperative outcomes. Using Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator and compared in-hospital mortality, ICU-level complications, 30-day readmissions, non-home discharge, length of hospitalization, and hospital-related costs among frail and non-frail subjects using χ² tests, patients’ frailty status was established. In comparison to non-frail patients, frail subjects were more likely to have comorbid conditions, in-hospital mortality, ICU-level complications, non-home discharge, the longer length of stay, and the greater median cost of the index admission. For ICU-level complications, non-home discharge increased the length of stay, and hospital-related costs of any covariate, frailty was the most powerful independent predictor. Hence, frail patients who had undergone radical cystectomy were more likely to have adverse perioperative outcomes and higher odds of in-hospital mortality, ICU-level complications, non-home discharge, increased length of stay, and hospital-related costs than non-frail subjects. Moreover, preoperative consideration of frailty could be beneficial in clinical guidance and shared decision-making.