Postoperative Adverse Outcomes in Patients With Frailty Undergoing Urologic Surgery Among American Patients: A Propensity-Score Matched Retrospective Cohort Study

Cheng-Wei Hsu,1,2 Chuen-Chau Chang,1,3,4 Fai Lam,1,3 Ming-Che Liu,5,6 Chun-Chieh Yeh,7,8 Ta-Liang Chen,3,4,9 Chao-Shun Lin,1,3,4,* Chien-Chang Liao1,3,4,10,11,* 1Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 2Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan; 3Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 4Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 5Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan; 6School of Dental Technology, College of oral Medicine, Taipei Medical University, Taipei, Taiwan; 7Department of Surgery, China Medical University Hospital, Tachung, Taiwan; 8Department of Surgery, University of Illinois, Chicago, IL, USA; 9Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 10Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 11School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Chien-Chang Liao, Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St, Taipei, 110, Taiwan, Tel +886 2 2737 2181 (ext. 8310), Fax +886 2 2736 7344, Email [email protected]; [email protected]: Although the 5-item modified frailty index (mFI-5) has been found to be associated postoperative outcomes, there are limited studies examining its utility in urologic surgery. Our purpose is to evaluate the association between the mFI-5 and postoperative mortality and complications among patients undergoing urologic surgery.Methods: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020. All adult patients who underwent urologic procedures were included. The mFI-5 includes five items: hypertension, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and physical function status. Each item is assigned one point, and an mFI-5 score of 2 or greater indicates frailty. The primary outcome was postoperative mortality, while secondary outcomes were postoperative complications. Propensity score analysis was employed to control for confounders.Results: After propensity score matching, each group contained 55,322 surgical patients. The patients in the frailty group were at risks of in-hospital mortality (absolute risk increase [ARI] 0.29%) and higher postoperative complications, including acute myocardial infarction (ARI 0.25%), pneumonia (ARI 0.42%), sepsis (ARI 0.41%), and septic shock (0.2%). Compared to the non-frailty group, the length of hospital stay was higher in the frailty group.Conclusion: Patients with an mFI-5 score of 2 or greater were associated with an increased risk of postoperative mortality and complications, including myocardial infarction, pneumonia, sepsis, and septic shock. The mFI-5 is a simple index that quickly identifies frail patients. This allows for the implementation of prehabilitation and nutritional strategies targeted at enhancing their physiological reserve and optimizing their surgical outcomes.Keywords: frailty, surgery, mortality, complications