Urologic Surgeries Complicated by Frailty

The more frail the patient, the greater the likelihood of complications, such as hospital readmission and blood transfusion.
The more frail the patient, the greater the likelihood of complications, such as hospital readmission and blood transfusion.

Frailty is strongly associated with short-term postoperative complications among patients undergoing most urologic surgeries, according to researchers. The association was significant across age groups, type of complications, and various procedure types, they found.

“These findings highlight the importance of preoperative frailty assessment and how this assessment can enhance surgical decision-making among physicians, patients and their families for optimized postoperative procedures,” Anne M. Suskind, MD, of the University of California San Francisco, and colleagues concluded in an online report in BJU International.

Not all urologic surgeries were significantly associated with an increased risk of complications. These exceptions include prostatectomy with lymph node dissection, prostatectomy with extended lymph node dissection, cystectomy, sling procedures for urinary incontinence, and orchiectomy.

Dr. Suskind's group analyzed data from 95,108 cases representing 21 different urologic procedures in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). They assessed frailty using a frailty index (FI) designed specifically for use with NSQIP data. The index includes 11 items: history of diabetes; impaired functional status; history of chronic obstructive pulmonary disease or pneumonia; history of congestive heart failure; history of myocardial infarction within 6 months of surgery; history of percutaneous coronary intervention cardiac surgery or angina; receipt of hypertensive medications; peripheral vascular disease or rest pain; impaired sensorium; transient ischemic attack or cerebrovascular accident (CVA); and CVA with deficit defined by history of CVA with persistent residual dysfunction. Items are summed and divided by 11 for the composite score. For example, an FI score of 1/11 would be 0.09 and a score of 2/11 would be 0.18, the researchers explained. “This index has been shown to have excellent correlation with both mortality and morbidity in all surgical subspecialties,” the authors noted.

Increasing frailty was associated with significantly increasing odds of complications. Patients with an FI of 0.09 had 28% increased odds of complications in adjusted analyses, whereas patients with an FI of 0.18 or higher had 74% increased odds.

The researchers classified complications as either minor (such as urinary tract infection, superficial wound infection, pneumonia, and blood transfusion) or major (such as hospital readmission, return to the operating suite, sepsis, deep vein thrombosis, CVA, reintubation, renal failure, myocardial infarction, pulmonary embolus). The most frequent minor complication was blood transfusion, which was required in 4.6% of cases; the most frequent major complication was hospital readmission, which was required in 6.2% of cases.

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