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Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

Published: January 12, 2020
Category: Bibliography
Authors: Alberto Briganti MD, Alessandro Larcher MD, Anil Kapoor MD, Carlotta Palumbo MD, Francesco Montorsi MD, Fred Saad MD, Giuseppe Rosiello MD, Lara Franziska Stolzenbach MD, Marina Deuker MD, Pierre I. Karakiewicz MD, Shahrokh F. Shariat MD, Umberto Capitanio MD, Zhe Tian MSc
Country: United States
Language: English
Type: Population Health
Setting: Hospital

Abstract

Background

To investigate the effect of frailty on short‐term postoperative outcomes and total hospital charges (THCs) in patients with non‐metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU).

Methods

Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000‐2015). We used the Johns Hopkins frailty‐indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied.

Results

Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P < .001). Frail patients exhibited higher rates (all P < .05) of overall complications (62.6% vs 50.9%), in‐hospital mortality (1.6% vs 1.0%), non‐home–based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P < .05) overall complications (OR, 1.46), in‐hospital mortality (OR, 1.52), non‐home–based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806).

Conclusion

Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short‐term postoperative complications, as well as longer LOS and higher THCs after RNU.

RNU, urinary tract carcinoma, radical nephroureterectomy

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