Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

Abstract

Background To investigate the effect of frailty on short‐term postoperative outcomes and total hospital charges (THCs) in patients with non‐metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU). Methods Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000‐2015). We used the Johns Hopkins frailty‐indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied. Results Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P < .001). Frail patients exhibited higher rates (all P < .05) of overall complications (62.6% vs 50.9%), in‐hospital mortality (1.6% vs 1.0%), non‐home–based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P < .05) overall complications (OR, 1.46), in‐hospital mortality (OR, 1.52), non‐home–based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806). Conclusion Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short‐term postoperative complications, as well as longer LOS and higher THCs after RNU.

Frailty assessment and postoperative complications in urologic oncology operations

“…There is an increasing need for the establishment of widely accepted specific urologic oncology calculators to predict the association between frailty and postoperative complications. However, due to the current lack of such specific indexes the use of a combination of the most accurate calculators is recommended to predict and prevent postoperative complications associated with frailty 9,14,[21][22] .…”

“…Frailty. Five phenotypic criteria: unintentional weight loss, exhaustion, low energy expenditure, low grip strength, and/or slowed walking speed 21 .…”

“…In patients with non-metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU), preoperative frailty has been associated with higher short-term postoperative complications, as well as longer length of stay (LOS) and higher total hospital charges (THCs)[ 21 ].…”

“…The Johns Hopkins frailty-indicator was used to stratify patients according to frailty status in a study that included 11 258 RNU patients from the National Inpatient Sample (NIS) database (2000-2015). Frail patients exhibited significantly higher rates of overall complications (62.6% vs 50.9%), in-hospital mortality (1.6% vs 1.0%), non-home-based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644)[ 21 ]. The Johns Hopkins frailty-indicator includes five phenotypic criteria: unintentional weight loss, exhaustion, low energy expenditure, low grip strength, and/or slowed walking speed[ 21 ].…”

Frailty, geriatric assessment and prehabilitation in elderly patients undergoing urological surgery – is there a need for change of the daily clinical practice? Synthesis of the available literature

“…The prevalence varies between studies. Rosiello et al [ 11 ] in a large study found it to be 16% in a group undergoing radical nephroureterectomy. In the group undergoing radical cystectomy in the study of Michel et al [ 12 ] it was 7%, while in the study of Yao-Dan Liang et al [ 13 ] the prevalence in different surgical wards was 18.8% to 41.9%.…”