Mp03-04 the Impact of Frailty on Surgical Outcomes Following Male Stress Urinary Incontinence Surgery: A National Study of Medicare Beneficiaries

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)1 May 2024MP03-04 THE IMPACT OF FRAILTY ON SURGICAL OUTCOMES FOLLOWING MALE STRESS URINARY INCONTINENCE SURGERY: A NATIONAL STUDY OF MEDICARE BENEFICIARIES Farnoosh Nik-Ahd, Leo D. Dreyfuss, Lufan Wang, Abigail Shatkin-Margolis, W. John Boscardin, Lindsay A. Hampson, Benjamin N. Breyer, Kenneth Covinsky, and Anne M. Suskind Farnoosh Nik-AhdFarnoosh Nik-Ahd , Leo D. DreyfussLeo D. Dreyfuss , Lufan WangLufan Wang , Abigail Shatkin-MargolisAbigail Shatkin-Margolis , W. John BoscardinW. John Boscardin , Lindsay A. HampsonLindsay A. Hampson , Benjamin N. BreyerBenjamin N. Breyer , Kenneth CovinskyKenneth Covinsky , and Anne M. SuskindAnne M. Suskind View All Author Informationhttps://doi.org/10.1097/01.JU.0001009488.55564.85.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is a common complication after treatment for prostate cancer. Subsequent SUI surgery, including artificial urinary sphincter (AUS) and male urethral sling placement, is commonly performed in older men, many of whom are also frail. Frailty, a state of decreased physiologic reserve and function, has been shown to increase the risk of AUS removal and post-operative complications. This study examined the association between frailty and postoperative complications and procedure revisions in men undergoing AUS and male urethral sling placement. METHODS: This is a retrospective cohort study of 100% fee-for-service Medicare beneficiaries ages 66 years and older who underwent AUS or male urethral sling placement between 2014-2016. Baseline frailty was quantified for each subject using the Claims-Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and comorbidity was quantified using the Charlson comorbidy index (CCI). Subjects were categorized as not frail (CFI<0.15), pre-frail (0.15≤CFI<0.25), and mildly-to-severely frail (CFI≥0.25). Primary outcomes were 30-day post-operative complications and AUS/male urethral sling removal or revision. RESULTS: In total, 7252 beneficiaries underwent SUI surgery: 2739 underwent male urethral sling placement and 4514 underwent AUS. Beneficiaries were not frail (N=3936, 54.27%), pre-frail (N=2995, 41.3%) and mildly-to-severely frail (N=321, 4.43%). Increased risk of 30-day post-operative complications was associated with pre-frail and mildly-to-severely frail compared to not frail (RR 1.47, p<0.001 and RR 2.46, p<0.001, respectively), age ≥75 years compared to 65-74 years (global p-value <0.001), and CCI ≥1 compared to 0 (global p-value <0.001). Beneficiaries who were pre-frail (RR 1.17, p=0.03) and mildly-to-severely frail (RR 1.31, p=0.04) or age ≥75 years compared to age 65-74 (global p-value=0.0002) were at significantly higher risk of AUS or sling revision or removal within 1 year, though this was not associated with CCI (global p-value=0.2). CONCLUSIONS: Among beneficiaries undergoing surgery for male SUI, frailty, age, and comorbidity were significantly associated with 30-day surgical complications, but only age and frailty were associated with AUS/male urethral sling revision and removal. These findings suggest that frailty is an important factor in the preoperative assessment of patients undergoing consideration for male SUI surgery and may be a predictor of adverse surgical outcomes. Source of Funding: NIH-NIA R01AG058616, R38AG070171 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e23 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Farnoosh Nik-Ahd More articles by this author Leo D. Dreyfuss More articles by this author Lufan Wang More articles by this author Abigail Shatkin-Margolis More articles by this author W. John Boscardin More articles by this author Lindsay A. Hampson More articles by this author Benjamin N. Breyer 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 ...