Transurethral Resection of Bladder Tumor Outcomes Are Predicted by a 5-Item Frailty Index

Abstract

ObjectiveTo evaluate the mFI-5 as a predictor of post-operative outcomes following transurethral resection of bladder tumor (TURBT). MethodsThe National Surgical Quality Improvement Program database was queried for TURBT cases from 2015-2019. mFI-5 scores were calculated by assigning a point to COPD, CHF, dependent functional status, hypertension, and diabetes. Patients were stratified by mFI-5 scores. Demographics and 30-day outcomes including Clavien-Dindo (CD) complications, mortality, and increased healthcare resource utilization (HCRU) were compared. HCRU outcomes included prolonged length of stay (PLOS), unplanned readmission (UR), and discharge to continued care (DCC). Multivariate regression assessed the predictive value of mFI-5 scores on outcomes. Results40,278 TURBT cases were identified (mFI-5 = 0: 12,400, mFI-5 = 1: 17,328, mFI-5 = 2: 9,225, mFI-5 ≥ 3: 1,416). Patients with higher mFI-5 scores were more likely to be older, male, White, and have larger tumors, all p < 0.05. Increasing mFI-5 scores resulted in increased frequency of all adverse outcomes, all p < 0.001. On multivariate analysis, mFI-5 ≥ 3 classification was a predictor of CD I/II (OR = 1.280), CD IV (OR = 2.539), mortality (OR = 2.202), HCRU (OR = 2.094), PLOS (OR = 2.136), DCC (OR = 3.401), and UR (OR = 1.705), all p < 0.05. A mFI-5 ≥ 3 demonstrated a sensitivity ranging from 6.0 – 13.5% and a specificity ranging from 96.6 – 97.0% for all outcomes. ConclusionsThe mFI-5 is an easily ascertainable pre-operative risk assessment tool that is a predictor of adverse clinical and HCRU outcomes following TURBT.