OBJECTIVE: To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure. METHODS: This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2013. Frailty was quantified using the NSQIP-FI (frailty index) and was applied to logistic regression models predicting 30-day complications (overall, major, and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure). RESULTS: We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% confidence interval 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% confidence interval 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, P<.01). CONCLUSION: Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.

Objective

To compare the associations between frailty indices and postoperative complications among older adults undergoing common urologic procedures. Frailty is known to be strongly associated with poor postoperative complications; however, the optimal way to measure frailty remains unknown.

Methods

We identified the 20 most common urologic procedures from 2013-2016 in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Frailty was measured using the NSQIP frailty index, simplified frailty index, and Risk Analysis Index. Multivariable logistic regression models were performed with each index and the American Society of Anesthesiologists (ASA) classification system with postoperative complications (any, major, or minor) as the outcomes. Statistical models were compared using the following fit parameters: area under the curve, Akaike information criterion, and Bayesian information criterion.

Results

A total of 158,855 procedures were identified. All frailty indices (NSQIP frailty index, simplified frailty index, and Risk Analysis Index) and ASA were associated with increased odds for any, major, and minor complications (all P values <.001). ASA demonstrated stronger model fit parameters for any, major and minor complications compared to all other indices, with an area under the curve of 0.63, 0.64, and 0.64, respectively (all P values <.001). Adding ASA to each frailty index resulted in slight improvement of model fit parameters (P value <.001).

Conclusion

ASA slightly outperforms current frailty indices in predicting postoperative complications among individuals undergoing commonly performed urologic procedures. Our findings highlight the need for improved frailty measures for preoperative risk assessment.

Objective

To compare the associations between frailty indices and postoperative complications among older adults undergoing common urologic procedures. Frailty is known to be strongly associated with poor postoperative complications; however, the optimal way to measure frailty remains unknown.

Methods

We identified the 20 most common urologic procedures from 2013-2016 in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Frailty was measured using the NSQIP frailty index, simplified frailty index, and Risk Analysis Index. Multivariable logistic regression models were performed with each index and the American Society of Anesthesiologists (ASA) classification system with postoperative complications (any, major, or minor) as the outcomes. Statistical models were compared using the following fit parameters: area under the curve, Akaike information criterion, and Bayesian information criterion.

Results

A total of 158,855 procedures were identified. All frailty indices (NSQIP frailty index, simplified frailty index, and Risk Analysis Index) and ASA were associated with increased odds for any, major, and minor complications (all P values <.001). ASA demonstrated stronger model fit parameters for any, major and minor complications compared to all other indices, with an area under the curve of 0.63, 0.64, and 0.64, respectively (all P values <.001). Adding ASA to each frailty index resulted in slight improvement of model fit parameters (P value <.001).

Conclusion

ASA slightly outperforms current frailty indices in predicting postoperative complications among individuals undergoing commonly performed urologic procedures. Our findings highlight the need for improved frailty measures for preoperative risk assessment.

Objective

To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure.

Methods

This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2013. Frailty was quantified using the NSQIP-FI (frailty index) and was applied to logistic regression models predicting 30-day complications (overall, major, and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure).

Results

We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% confidence interval 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% confidence interval 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, P<.01).

Conclusion

Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.