MP29-05: The modified 5-item frailty index as a predictor of perioperative risk in patients undergoing percutaneous nephrolithotomy
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
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Author Block
Kays Chaker*, Yassine Ouanes, Makram Rinchi, Mahdi Marrak, Mokhtar Bibi, Kheireddine Mrad Dali, Moez Rahoui, Karem Abid, Yassine Nouira, Tunis, Tunisia
Introduction
The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL.
Methods
A database of patients undergoing PCNL, between 2015 and 2021, was analyzed. Clinical and intra-operative data including, demographics, relevant labs, number of punctures, stone location, and stone characteristics were analyzed. Patient frailty was assessed using the mFI-5 index, which is assessed between 0 to 5 for the cumulative presence of the five components. The mFI-5 index was calculated based on the presence of the 5 co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 > 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospital utilization: total hospital length of stay, reoperation, and unplanned readmission. ANOVA analyses, Chi-Squared analyses, and Spearman’s correlations were conducted to determine potential group diferences and potential associations. A p value of <0.05 was considered statistically significant.
Results
From a total of 320 PCNL patients included for analysis, 54.06% (n=173) were not frail, 17.81% (n=57) were intermediate, and 28.12% (n=90) were severely frail. There were no differences in blood loss, number of dilations, presence of a staghorn calculus, laterality, or location of dilation. Frail patients were likely to be older (p=0.002) and have a higher American Society of Anesthesiologists score (p=0.001) and Charlson comorbidity index (p=0.03). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p=0.042), significant blood loss (p=0.036) and require intensive care units admissions (p=0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require, reoperation, and unplanned readmission (p=0.02).
Conclusions
Frailty assessment appears useful stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.
Source Of Funding
None
Author Block
Kays Chaker*, Yassine Ouanes, Makram Rinchi, Mahdi Marrak, Mokhtar Bibi, Kheireddine Mrad Dali, Moez Rahoui, Karem Abid, Yassine Nouira, Tunis, Tunisia
Introduction
The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL.
Methods
A database of patients undergoing PCNL, between 2015 and 2021, was analyzed. Clinical and intra-operative data including, demographics, relevant labs, number of punctures, stone location, and stone characteristics were analyzed. Patient frailty was assessed using the mFI-5 index, which is assessed between 0 to 5 for the cumulative presence of the five components. The mFI-5 index was calculated based on the presence of the 5 co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 > 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospital utilization: total hospital length of stay, reoperation, and unplanned readmission. ANOVA analyses, Chi-Squared analyses, and Spearman’s correlations were conducted to determine potential group diferences and potential associations. A p value of <0.05 was considered statistically significant.
Results
From a total of 320 PCNL patients included for analysis, 54.06% (n=173) were not frail, 17.81% (n=57) were intermediate, and 28.12% (n=90) were severely frail. There were no differences in blood loss, number of dilations, presence of a staghorn calculus, laterality, or location of dilation. Frail patients were likely to be older (p=0.002) and have a higher American Society of Anesthesiologists score (p=0.001) and Charlson comorbidity index (p=0.03). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p=0.042), significant blood loss (p=0.036) and require intensive care units admissions (p=0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require, reoperation, and unplanned readmission (p=0.02).
Conclusions
Frailty assessment appears useful stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.
Source Of Funding
None