Frailty may increase the risk for complications, repeat procedures, and death after sling surgery in women, a new study finds.

Using 2014-2016 Medicare data, investigators stratified 54,112 women aged 66 years and older who underwent sling surgery (with or without concomitant prolapse repair) by frailty status. The Claims-based Frailty Index (CFI) described 4 categories: not frail (CFI less than 0.15), pre-frail (0.15-0.25), mildly frail (0.25-0.35), and moderately-severely frail (0.35 or more). Of the cohort, 4.8% patients were mildly frail and 0.4% were moderately to severely frail.

On multivariate analysis, the relative risk for 30-day complications was significantly increased 1.8- and 2.5-fold among mildly and moderately to severely frail patients, respectively, compared with patients who were not frail, Michelle E. Van Kuiken, MD, and colleagues from the University of California, San Francisco reported in The Journal of Urology. Moderately to severely frail women experienced high rates of urinary tract infections (UTI; 15.7%), cardiovascular complications (19.9%), and pulmonary complications (9.4%). The relative risk for UTIs was significantly increased 1.7- and 2.4-fold in the mild and moderate-severe frailty groups, respectively.

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Frailty also significantly increased the risk for repeat sling surgery, urethral bulking, sling revision, or urethrolysis procedures for persistent incontinence or obstructed voiding within 1 year by 1.4-fold, the investigators reported.

Dr Van Kuiken and colleagues found that the relative risk for 1-year mortality was significantly increased 3.4- and 6.7-fold among the mildly and moderately-severe frail groups, respectively, compared with the no-frailty group.

Frailty was independently associated with these increased risks even after adjusting for age, Charlson comorbidity index, and concomitant pelvic organ prolapse repair “demonstrating the value of assessing frailty independently.” Even patients with pre-frail status had significantly increased risks for complications, repeat procedures, and death.

“Our findings underscore the importance of considering and measuring frailty in the preoperative setting, as an emerging body of evidence demonstrates the negative association that frailty has on the risk of postoperative complications,” Dr Van Kuiken’s team stated.


Van Kuiken ME, Zhao S, Covinsky K, Boscardin J, Finlayson E, Suskind AM. Frailty is associated with an increased risk of complications and need for repeat procedures after sling surgery in older adults. J Urol. Published online January 21, 2022. doi:0.1097/JU.0000000000002441