Pd24-01 Urogold: A Novel Surgical Risk Calculator for Older Women Undergoing Surgery for Stress Urinary Incontinence or Pelvic Organ Prolapse

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)1 May 2024PD24-01 UROGOLD: A NOVEL SURGICAL RISK CALCULATOR FOR OLDER WOMEN UNDERGOING SURGERY FOR STRESS URINARY INCONTINENCE OR PELVIC ORGAN PROLAPSE Farnoosh Nik-Ahd, Shoujun Zhao, Lufan Wang, W. John Boscardin, Kenneth Covinsky, and Anne M. Suskind Farnoosh Nik-AhdFarnoosh Nik-Ahd , Shoujun ZhaoShoujun Zhao , Lufan WangLufan Wang , W. John BoscardinW. John Boscardin , Kenneth CovinskyKenneth Covinsky , and Anne M. SuskindAnne M. Suskind View All Author Informationhttps://doi.org/10.1097/01.JU.0001008840.07763.8d.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) repair are common in older women, many of whom have additional vulnerabilities that increase surgical risk, such as frailty. This study describes the creation of UroGOLD, a novel surgical risk calculator that specifically factors in frailty for older women undergoing POP surgery. METHODS: This is a retrospective cohort study of Medicare beneficiaries undergoing SUI/POP surgery in 2014-2016. Baseline frailty was calculated using the Claims-Based Frailty Index (CFI), a validated measure of frailty comprised of 93 variables (not frail CFI<0.15; pre-frail 0.15≤CFI<0.25; mildly frail 0.25≤CFI<0.35; moderately-to-severely frail CFI≥0.35). Each variable in the CFI and Charlson Comorbidity Index was extrapolated into stepwise logistic regression models to determine which variables were most predictive of postoperative complications. The most predictive variables were then combined into categories. Calibration curves and tests of model fit, including C-statistics, Brier scores, and Spiegelhalter p-values were calculated to ensure prognostic accuracy for outcomes of interest. RESULTS: In total, 108,479 subjects were included. Mean age was 73.6 years and the majority (91.7%) were White. Approximately 50,356 subjects (46.4%) had CFI scores consistent with prefrail, 4,752 (4.4%) had CFI scores consistent with mildly frail, and 362 (0.3%) had CFI scores consistent with moderately-to-severely frail. Thirteen prognostic variable categories were deemed most predictive of complications of interest. All models had low Brier scores, indicating high model accuracy, and high C-statistic and Spiegelhalter p-values, indicating excellent model discrimination and calibration, respectively. Each outcome also demonstrated excellent model fit on calibration curves (Figure 1). CONCLUSIONS: UroGOLD is a novel, free online resource for older women undergoing SUI/POP surgery that specifically factors in frailty. In all models, UroGOLD demonstrated high accuracy, calibration, and discrimination. Available to patients and clinicians, UroGOLD will be a valuable tool, particularly as the population continues to age and more older, frail women are considered for surgical intervention. Download PPT Source of Funding: NIH-NIA R01AG058616-01, R38AG070171 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e530 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Farnoosh Nik-Ahd More articles by this author Shoujun Zhao More articles by this author Lufan Wang More articles by this author W. John Boscardin More articles by this author Kenneth Covinsky More articles by this author Anne M. Suskind More articles by this author Expand All Advertisement PDF downloadLoading ...