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characteristics consisted of age, Charlson Comorbidity Index, surgical approach (retropubic vs. robot-assisted vs. laparoscopic vs. perineal), status of lymph node dissection (LND) and nerve-sparing procedure, hospital district, hospital region and hospital volume. We examined the rate of blood transfusion, intra-and postoperative complications, inhospital mortality, length of stay (LOS) and hospital charges using validated methodology.RESULTS: Overall, 25,333 men underwent RP. Of these, 16,372 (64.6%) men were treated by retropubic, 5,657 (22.3%) by robot-assisted, 2,730 (10.8%) by laparoscopic and 574 (2.3%) by perineal RP. The rate of LND and nerve-sparing procedure was 84.1 and 52.8%, respectively. The rate of autologous and allogeneic blood transfusion was 0.3 and 8.8%, respectively. Intraoperative complications were recorded in 2.7%. Specifically, rectal laceration, ureteral injury and nerve-or vessel injury were recorded in 1.5, 0.7 and 1.1%, respectively. Postoperative complications were recorded in 26.7%. Specifically, 2.7% of patients suffered from cardial, 1.1% from respiratory, 4.0% from wound, 1.6% from vascular, 8.6% from genitourinary, 7.5% from miscellaneous medical and 13.2% from miscellanoeous surgical complications. In-hospital mortality was 0.2%. Mean LOS was 10.8 days. Mean hospital charges were 7,409 Euro. Results from multivariable logistic regression analyses will be presented at the congress.CONCLUSIONS: Institutional results should ideally be compared to nationally representative data. In 2012, RP in Germany was performed in 33% in a minimally-invasive fashion, the most temporal overall postoperative complication rate was 27%.

INTRODUCTION AND OBJECTIVES: Payers are increasingly focusing on preventable complications and readmissions as they seek greater healthcare value. Benign prostate hyperplasia (BPH) with lower urinary tract symptoms occurs in almost 90% of men over 80, and many of these elderly men with multiple comorbidities eventually undergo surgery for poor urinary quality of life or frank urinary retention. Measures of patient frailty are potentially useful to identify such elderly men at risk for complications, thus we evaluated the predictive value of a frailty index in identifying BPH patients at risk for Clavien III, IV or V postoperative complications.METHODS: We identified all patients who underwent BPH surgery (TURP, laser coagulation, enucleation and vaporization) between 2005 and 2013 in the National Surgical Quality Improvement Program database. The modified frailty index (mFI) was calculated for each patient by scoring the presence/absence of comorbid conditions (Table 1). Univariate and multivariate analyses were performed to determine whether mFI and other clinical variables could independently predict serious complications.RESULTS: N¼18,827 patients (mean 71.7, SD¼ 9.3 years) underwent BPH surgery and 34.7% had mF¼0, 47% had mFI¼1, 12.3% had mFI¼2, 4.1% had mFI¼3, and 1.8% had mFI 4. Univariate analysis showed that higher mFI was associated with 2-fold increased risk of any complication (p<0.01) overall, but when stratified only for men over age 70, a 5-fold increased risk (p <0.0001) was noted. Multivariate regression (Table 2) showed that among men under 70, only those with mFI 4 were at risk for complications whereas among men aged 70, mFI 1, 2, 3 and 4 had monotonically increasing odds of suffering a Clavien 3 complication. Lower preop albumin but not older age and BMI also predicted for increased risk of serious complications and readmissions.CONCLUSIONS: The frailty index is a simple and objective measure that independently predicts Clavien 3 complications in BPH patients undergoing transurethral resection or laser surgery. This index has greater predictive value in men 70.