Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity

Suskind, Anne M.; Jin, Chengshi; Cooperberg, Matthew R.; Finlayson, Emily; Boscardin, W. John; Sen, Sáunak; Walter, Louise C.

doi:10.1016/j.urology.2016.03.073

Cited by 50 publications

(24 citation statements)

References 19 publications

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“…Frailty is a measure of physiologic vulnerability that manifests as increased susceptibility to adverse events such as falls, disability, loss of independence, and death . Among older individuals undergoing surgery, frailty has been linked to increased risk of postoperative complications and prolonged periods of recovery . Several validated measures that can be used to define frailty–a complex physiologic state.…”

Section: Introductionmentioning

confidence: 99%

The impact of frailty on treatment for overactive bladder in older adults

Suskind

Kowalik

Quanstrom

et al. 2019

Neurourology and Urodynamics

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Aims: To examine the impact of frailty on treatment outcomes for overactive bladder (OAB) in older adults starting pharmacotherapy, onabotulinumtoximA, and sacral neuromodulation. Methods: This is a prospective study of men and women age ≥60 years starting pharmacotherapy, onabotulinumtoxinA, or sacral neuromodulation. Subjects were administered questionnaires at baseline and again at 1- and 3-months. Frailty was assessed at baseline using the timed up and go test (TUGT), whereby a TUGT time of ≥12 seconds was considered to be slow, or frail. Response to treatment was assessed using the overactive bladder symptom score (OABSS) and the OAB-q SF (both Bother and HRQOL subscales). Information on side effects/adverse events was also collected. Mixed effects linear modeling was used to model changes in outcomes over time both within and between groups. Results: A total of 45 subjects enrolled in the study, 40% (N=18) of whom had a TUGT ≥12 seconds. Both TUGT groups demonstrated improvement in OAB symptoms over time and there were no statistically significant differences in these responses per group (all p-values >0.05). Similar trends were found for both OAB-q SF Bother and OAB-q SF HRQOL questionnaire responses. Side effects and adverse events were not significantly different between groups (all p’s >0.05). Conclusions: Adults ≥60 years of age starting second- and third-line treatments for OAB, regardless of TUGT time, demonstrated improvement in OAB symptoms at 3 months. These findings suggest that frail older adults may receive comparable benefit and similar rates of side effects compared to less frail older individuals.

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Section: Introductionmentioning

confidence: 99%

The impact of frailty on treatment for overactive bladder in older adults

Suskind

Kowalik

Quanstrom

et al. 2019

Neurourology and Urodynamics

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“…7 Although we have previously shown that frailty is common among older individuals undergoing urologic surgery using the National Surgical Quality Improvement Program (NSQIP) Frailty Index, 8 such frailty assessment tools are not commonly utilized in practice. 4 In recognition of the need to improve surgical care among older individuals, the American College of Surgeons NSQIP and the American Geriatric Society have jointly recommended a frailty preoperative assessment for all patients 65 and older.…”

Section: Introductionmentioning

confidence: 99%

The Timed Up and Go Test as a Measure of Frailty in Urologic Practice

Pangilinan

Quanstrom

Bridge

et al. 2017

Urology

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Objectives To evaluate the prevalence of frailty, a known predictor of poor outcomes, among patients presenting to an academic non-oncologic urology practice and to examine whether frailty differs among patients who did and did not undergo urologic surgery. Methods The Timed up and Go Test (TUGT), a parsimonious measure of frailty, was administered to patients ages ≥ 65. The TUGT, demographic data, urologic diagnoses and procedural history were abstracted from the medical record into a prospective database. TUGT times were categorized as nonfrail (≤10 sec), prefrail (11–14 sec) and frail (≥15 sec). These times were evaluated across age and urologic diagnoses and compared between patients who did and did not undergo urologic surgery using chi-square and t-tests. Results The TUGT was recorded for 78.9% of patient visits from December 2015 to May 2016. For 1089 patients, average age was 73.3 ± 6.3 years; average TUGT time was 11.6 ± 6.0 sec; 30.0% were categorized as prefrail and 15.2% as frail. TUGT times increased with age, with 56.9% of patients age 86 and over categorized as frail. Times varied across diagnoses (highest average TUGT was 14.3 ± 11.9 sec for patients with urinary tract infections), however no difference existed between patients who did and did not undergo surgery (p = 0.94). Conclusions Among our population, prefrailty and frailty were common, TUGT times increased with age and varied by urologic diagnosis, but did not differ between patients who did and did not undergo urologic surgery, presenting an opportunity to consider frailty in preoperative surgical decision making.

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“…delirium and falls) that are related to non-home discharge. The evidence showed that a higher proportion of patients discharged to a location other-than-home experienced early mortality after RC compared to those discharged home [24,37,38]. Therefore, still bearing in mind the possible risk of selection bias related to the frail population, the increased rate of non-home discharge among frail patients undergoing RC could submit them to this additional risk of short-term mortality.…”

Section: Discussionmentioning

confidence: 99%

Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review

Ornaghi

Afferi

Antonelli

et al. 2020

Arab Journal of Urology

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Objective: To assess the prevalence of frailty, a status of vulnerability to stressors leading to adverse health events, in bladder cancer patients undergoing radical cystectomy (RC), and test the impact of frailty measurements on postoperative adverse outcomes. Methods: A systematic review of English-language articles published up to April 2020 was performed. Electronic databases were searched to quantify the frailty prevalence in RC patients and assess the predictive ability of frailty indexes on RC-related outcomes as postoperative complications, early mortality, hospitalization length (LOS), costs, discharge dispositions, readmission rate. Results: Eleven studies were selected. Patients' frailty was identified by Johns Hopkins indicator (JHI) in two studies, 11-item modified Frailty Index (mFI) in four, 5-item simplified FI (sFI) in three, 15-point mFI in one, Fried Frailty Criteria in one. Considering all the frailty measurements applied, 8% and 31% of patients were frail or pre-frail, respectively. Frail (43%) and pre-frail patients (35%) were more at risk of major complications compared to non-frail (27%) using sFI; with JHI the percentages of frail and non-frail were 53% versus 19%. According to JHI and mFI frailty was related to longer LOS and higher costs. JHI identified that 3% of frail patients experience inhospital mortality versus 1.5% of non-frail. Finally, using sFI, frail (28%), and pre-frail (19%) were more likely to be discharged non-home compared to non-frail patients (8%) and had a higher risk of 30-day mortality (4% and 2% versus 1%). Conclusions: Almost half of RC patients were frail or pre-frail, conditions significantly related to an increased risk of postoperative adverse events with higher rates of major complications and early mortality. The most-used frailty index was mFI, while JHI and sFI resulted the most reliable to predict early postoperative RC-related adverse outcomes and should be routinely included in clinical practice after better standardization throughout prospective comparative studies.

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Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity

Cited by 50 publications

References 19 publications

The impact of frailty on treatment for overactive bladder in older adults

The impact of frailty on treatment for overactive bladder in older adults

The Timed Up and Go Test as a Measure of Frailty in Urologic Practice

Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review

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