BACKGROUND: Surgical risk calculators are not often routinely used in Urology Multidisciplinary Meetings (MDM), and little is known about their impact on clinical decision-making. The aim of this study is to assess the utility of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator for decision-making in the Urology MDM setting, with particular consideration given to decisions about surgical candidacy. METHODS: We analysed all adult patients discussed in our Urology MDM with urological conditions whose management plan could potentially include major surgery. During a MDM, a consensus management decision was made prior to the NSQIP score being revealed to blinded team members. Any change in decision after revealing the score was documented, including rationale. RESULTS: Sixty-three out of 64 eligible cancer cases being discussed at MDM warranted NSQIP scores being revealed to the MDM post initial consensus. 95.2% (n = 60) did not have a change in the MDM management plan after reveal of NSQIP score. The NSQIP score led to a change in the MDM management decision in three cases: two renal cancer cases where management changed to biopsy with view to microwave ablation if positive, and one prostate cancer case, where management changed to recommend against radical prostatectomy. CONCLUSION: The NSQIP risk calculator was a useful tool and adjunct in the MDM setting. It served as a safety net where surgical risk was not initially properly estimated by team members, and reinforced decisions where there was concordance between NSQIP score and clinical judgement.