PD12-07 PREOPERATIVE FRAILTY PREDICTS ADVERSE SHORT-TERM POST-OPERATIVE OUTCOMES IN PATIENTS TREATED WITH PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD12)1 Sep 2021PD12-07 PREOPERATIVE FRAILTY PREDICTS ADVERSE SHORT-TERM POST-OPERATIVE OUTCOMES IN PATIENTS TREATED WITH PARTIAL NEPHRECTOMY Giuseppe Rosiello, Giuseppe Fallara, Alberto Martini, Gianmarco Colandrea, Giuseppe Basile, Daniele Cignoli, Francesco Trevisani, Arianna Bettiga, Cristina Giancristofaro, Martina Romani, Avnish Kapoor, Shahrokh F. Shariat, Pierre Karakiewicz, Zhe Tian, Alberto Briganti, Francesco Montorsi, Andrea Salonia, Alessandro Larcher, and Umberto Capitanio Giuseppe RosielloGiuseppe Rosiello More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Alberto MartiniAlberto Martini More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Francesco TrevisaniFrancesco Trevisani More articles by this author , Arianna BettigaArianna Bettiga More articles by this author , Cristina GiancristofaroCristina Giancristofaro More articles by this author , Martina RomaniMartina Romani More articles by this author , Avnish KapoorAvnish Kapoor More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Pierre KarakiewiczPierre Karakiewicz More articles by this author , Zhe TianZhe Tian More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001987.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty is a key aspect, related to-but distinct from-comorbidities and age. Partial nephrectomy (PN) use has increased during the last decades. However, PN is a complex procedure, not devoid of complications. Thus, the search for accurate and independent indicator of suboptimal outcomes after PN, other than well-established predictors of adverse surgical outcomes, appears warranted. In consequence, we investigated the effect of frailty on postoperative outcomes and hospital costs in patients treated with PN. METHODS: Within the National Inpatient Sample database, we identified 17,533 patients treated with PN between 2008 and 2015. The Johns Hopkins frailty indicator was applied, to identify frail patients treated with PN. Multivariable logistic, Poisson and linear regression models were applied to test the effect of frailty on overall complications, major complications, non home based (NHB) discharge, length of stay (LOS) and total hospital charges (THCs). All analyses were adjusted for several confounders, including demographic and patient characteristics, surgical approach and hospital variability. RESULTS: Overall, 2,745 (16%) frail patients were included. Rates of frail patients increased over time, from 14% in 2008 to 19% in 2015 (p <0.01). Frail patients experienced higher rates (all p <0.001) of overall complications (43 vs. 29%), major complications (17 vs. 10%), blood transfusions (11 vs. 7.7%), NHB discharge (13 vs. 8%), longer LOS (4 vs. 3) and higher THCs ($33,550 vs. $31,032$). Moreover, frailty status independently predicted (all p <0.001) overall complications (Odds ratio [OR]: 1.62, 95%CI 1.47-1.78), major complications (OR: 1.46; 95%CI 1.29-1.65), blood transfusions (OR: 1.38; 95%CI 1.19-1.61), NHB discharge (OR:1.48; 95%CI 1.29-1.70), longer LOS (Relative risk [RR]: 1.07; 95%CI 1.04-1.10) and higher THCs (RR: +$6,787; 95%CI +4,391 - + 9,184). Finally, of frail patients, 1,198 (44%) neither exhibited body mass index >30 nor CCI >2. CONCLUSIONS: A non-negligible rate of frail patients undergoes PN for renal mass. Frailty predicts unfavorable surgical outcomes, such as major complications or longer hospitalization. This translates into increased hospital costs. Roughly half of frail population does not exhibit other well-known risk factor for suboptimal outcomes after PN, such as obesity or CCI >2. Thus, evaluation of frailty index should be included into preoperative counselling, to identify patients at higher risk of developing complications, who may potentially benefit from more attentive evaluation. Source of Funding: © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e205-e205 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Rosiello More articles by this author Giuseppe Fallara More articles by this author Alberto Martini More articles by this author Gianmarco Colandrea More articles by this author Giuseppe Basile More articles by this author Daniele Cignoli More articles by this author Francesco Trevisani More articles by this author Arianna Bettiga More articles by this author Cristina Giancristofaro More articles by this author Martina Romani More articles by this author Avnish Kapoor More articles by this author Shahrokh F. Shariat More articles by this author Pierre Karakiewicz More articles by this author Zhe Tian More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement Loading ...