Key result
Preoperative frailty predicts ~46% more overall complications and higher in-hospital mortality after radical nephroureterectomy.
Why the study?
The study was designed to investigate the effect of frailty on short-term postoperative outcomes and total hospital charges in patients with non-metastatic upper urinary tract carcinoma treated with radical nephroureterectomy.
Does preoperative frailty predict adverse short-term postoperative outcomes and higher hospital charges in patients undergoing radical nephroureterectomy?
Cohort (n=11,258)
Yes
Does preoperative frailty predict adverse short-term postoperative outcomes and higher hospital charges in patients undergoing radical nephroureterectomy?
Odds Ratio: 1.46
Absolute Event Rate: 62.6% vs 50.9%
p-value: p=<0.05
Preoperative frailty is present in 16% of patients undergoing radical nephroureterectomy and independently predicts worse short-term postoperative outcomes and higher hospital costs.
May inform preoperative risk counseling; hypothesis-generating for frailty interventions in upper tract urothelial carcinoma.
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.
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Rosiello et al. (2020) conducted a cohort in Non-metastatic upper urinary tract carcinoma (n=11,258). Preoperative frailty vs. Non-frail patients was evaluated on Overall complications (OR 1.46, p=<0.05). Preoperative frailty in patients undergoing radical nephroureterectomy predicted higher rates of overall complications (62.6% vs 50.9%; OR 1.46, P<0.05) and in-hospital mortality (1.6% vs 1.0%).
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