V4-01 Our Successful Experience Utilizing Posterior Rhabdosphincter Reconstruction During Robotic Prostatectomy

Abstract

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.