Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database
Top Cited Papers
Open Access
- 21 December 2015
- journal article
- surgical education
- Published by Wiley in BJU International
- Vol. 117 (5), 836-842
- https://doi.org/10.1111/bju.13399
Abstract
Objectives To evaluate the association of frailty, a measure of diminished physiological reserve, with both major and minor surgical complications among patients undergoing urological surgery. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2007 to 2013, we identified all urological cases that appeared > 1000 times in the dataset among patients aged ≥40 years. Frailty was measured using the NSQIP frailty index (FI), a validated measure that includes 11 impairments, such as decreased functional status and impaired sensorium. We created multivariable logistic regression models using the NSQIP FI to assess major and minor complications after surgery. Results We identified 95 108 urological cases representing 21 urological procedures. The average frequency of complications per individual was 11.7%, with the most common complications being hospital readmission (6.2%), blood transfusion (4.6%) and urinary tract infection (3.1%). Major and minor complications increased with increasing NSQIP FI. Frailty remained strongly associated with complications after adjustment for year, age, race, smoking status and method of anaesthesia (adjusted odds ratio 1.74 [95% confidence interval 1.64, 1.85] for an NSQIP FI ≥0.18). Increasing NSQIP FI was associated with increasing frequency of complications within age groups (by decade) up to age 81 years and across most procedures. Conclusion Frailty strongly correlates with risk of postoperative complications among patients undergoing urological surgery. This finding is true within most age groups and across most urological procedures.Keywords
Funding Information
- National Institute of Diabetes and Digestive and Kidney Diseases (K12 DK83021‐07)
- National Institutes of Health (K24AG041180)
This publication has 15 references indexed in Scilit:
- Pre-surgical Geriatric Syndromes, Frailty, and Risks for Postoperative Delirium in Older Patients Undergoing Gastrointestinal Surgery: Prevalence and Red FlagsJournal of Gastrointestinal Surgery, 2015
- Use of the National Surgical Quality Improvement Program in Orthopaedic SurgeryClinical Orthopaedics & Related Research, 2015
- Relation of Frailty to Outcomes After Transcatheter Aortic Valve Replacement (from the PARTNER Trial)The American Journal of Cardiology, 2015
- Effect of frailty on short- and mid-term outcomes in vascular surgical patientsBritish Journal of Surgery, 2015
- Report of a Simplified Frailty Score Predictive of Short-Term Postoperative Morbidity and MortalityJournal of the American College of Surgeons, 2015
- Association of Hospital Participation in a Surgical Outcomes Monitoring Program With Inpatient Complications and MortalityJama-Journal Of The American Medical Association, 2015
- Quality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional studyWorld Journal of Emergency Surgery, 2013
- Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national databaseJournal of Surgical Research, 2013
- Frailty as a Predictor of Surgical Outcomes in Older PatientsJournal of the American College of Surgeons, 2010
- Geriatric UrologyJournal of the American Geriatrics Society, 2003