Mp24-15 Comparing Frailty Indices for Risk Stratification in Urologic Surgery: Which Index to Choose?

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP24)1 May 2024MP24-15 COMPARING FRAILTY INDICES FOR RISK STRATIFICATION IN UROLOGIC SURGERY: WHICH INDEX TO CHOOSE? Ekamjit S. Deol, Vidit Sharma, Anthony E. Fadel, Ranveer Vasdev, Grant Henning, Spyridon Basourakos, Matthew K. Tollefson, Igor Frank, R. Houston Thompson, Robert J. Karnes, Stephen A. Boorjian, and Abhinav Khanna Ekamjit S. DeolEkamjit S. Deol , Vidit SharmaVidit Sharma , Anthony E. FadelAnthony E. Fadel , Ranveer VasdevRanveer Vasdev , Grant HenningGrant Henning , Spyridon BasourakosSpyridon Basourakos , Matthew K. TollefsonMatthew K. Tollefson , Igor FrankIgor Frank , R. Houston ThompsonR. Houston Thompson , Robert J. KarnesRobert J. Karnes , Stephen A. BoorjianStephen A. Boorjian , and Abhinav KhannaAbhinav Khanna View All Author Informationhttps://doi.org/10.1097/01.JU.0001008860.46052.c4.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurately identifying frail patients has the potential to enhance surgical decision making, but a consensus on the ideal frailty screening tool has not been established. Numerous tools for identifying frailty in surgical patients have been proposed, but rarely has the predictive ability of various frailty indices been compared in the same cohort. Two of the most commonly used frailty indices are the Modified Frailty Index (mFI) and the revised Risk Analysis Index (revised RAI). Herein, we aim to compare the predictive ability of mFI to revised RAI among patients undergoing urologic procedures. METHODS: The NSQIP database was queried to identify patients undergoing radical prostatectomy, nephrectomy, or cystectomy between 2013-2017. Frailty was defined either using the 5-item mFI, or the revised RAI. Multivariable logistic regression analyses were performed to investigate the association of the two frailty indices with the following outcomes: unplanned readmission, 30-day mortality, major complication, and non-home discharge. Receiver-operating characteristic (ROC) curve was employed to compare the predictive performances of the two frailty instruments. Significance was determined by DeLong's test. RESULTS: The final cohort consisted of 101,739 patients, including 48,627 undergoing radical prostatectomy, 42,921 undergoing nephrectomy, and 10,191 undergoing radical cystectomy, Of these, 0.33%, 0.76%, 2.40% had death within 30 days of surgery, 2.40%, 13.54%, 26.86% had a major complication within 30 days of surgery, and 1.92%, 4.37%, 13.54% had a non-home discharge disposition within 30 days in the prostatectomy, nephrectomy and cystectomy cohorts, respectively. On ROC curve analysis, Revised-RAI showed higher discriminatory ability for mortality and non-home discharge than mFI, but both had similar discriminatory ability for major peri-operative complications (Figure 1). CONCLUSIONS: Revised RAI performed better than mFI in predicting postoperative mortality and discharge to non-home destination after major urologic surgery. This study highlights the variation in frailty indices, and suggests that revised RAI may have greater utility as a prognostic tool than mFI among urologic patients. Prospective studies and clinical trials that consider frailty should take these results into account during trial design. Download PPT Source of Funding: Thomas P. and Elizabeth S. Grainger Urology Fellowship Fund © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e398 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ekamjit S. Deol More articles by this author Vidit Sharma More articles by this author Anthony E. Fadel More articles by this author Ranveer Vasdev More articles by this author Grant Henning More articles by this author Spyridon Basourakos More articles by this author Matthew K. Tollefson More articles by this author Igor Frank More articles by this author R. Houston Thompson More articles by this author Robert J. Karnes More articles by this author Stephen A. Boorjian More articles by this author Abhinav Khanna More articles by this author Expand All Advertisement PDF downloadLoading ...