Frailty and surgical outcomes in genitourinary prosthetic procedures: an ACS-NSQIP comparative analysis of risk indices.

Abstract

Objectives: To evaluate the association between frailty and surgical outcomes using frailty indices and to assess tool performance. Genitourinary prosthetics, including artificial urinary sphincter (AUS), urethral sling, and penile prosthesis, are standard therapeutic interventions but are susceptible to complications. These procedures are often performed on older, frail patients, necessitating a deeper understanding of the relationship between frailty and postoperative morbidity.

Methods: We utilized data from the NSQIP database (2011-2020) to identify patients undergoing urologic prosthetic procedures, including artificial urinary sphincter, sling, and penile prosthesis. Frailty was assessed using the modified frailty index-5 (mFI-5), the Risk Analysis Index (RAI-A) and ASA Class. Primary outcomes focused on 30-day postoperative morbidity, with secondary outcomes including mortality, length of stay, discharge disposition, readmissions, and reoperations. Logistic and linear regression models were constructed, adjusting for relevant clinical variables, and ROC curve plotted to compare the predictive abilities of mFI-5, RAI-A, and ASA classification.

Results: We identified 4,734 patients who underwent AUS, sling, or penile prosthesis surgeries. Frailty, as measured by RAI-A (OR 2.05, 95% CI 1.59-2.65, p < 0.001) and ASA Class (OR 1.55, 95% CI 1.19-2.01, p = 0.001), was significantly associated with postoperative morbidity, while mFI-5 was not. Cardiovascular complications and discharge to continued care were associated with all tools. ROC curve analysis showed that RAI-A had significantly greater predictive ability for postoperative morbidity than mFI-5 (p = 0.023).

Conclusions: RAI-A and ASA are more effective than the mFI-5 in predicting postoperative morbidity, mortality, and other adverse outcomes in patients undergoing urologic prosthetic surgeries.