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Impact of frailty on clinical outcomes and resource utilization of hospitalizations for renal stone surgery

  • Original Article
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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 18 May 2024

Abstract

Purpose

Frailty is reportedly associated with poorer outcomes among surgical patients. Using a coding-based frailty tool, we investigated the impact of frailty on clinical outcomes and resource utilization for urolithiasis hospitalizations.

Methods

A cohort study using the 2018 National Inpatient Sample database. All adult elective hospitalizations for urolithiasis were included in the study. The study population was categorized into FRAIL and non-frail (nFRAIL) cohorts using the Johns Hopkins Adjusted Clinical Groups frailty clusters. The association between frailty and clinical and financial outcomes was evaluated using multivariate regression models.

Results

About 1028 (14.9%) out of 6900 total hospitalizations were frail. Frailty was not associated with a significant increase in the odds of in-hospital mortality (adjusted odds ratio (aOR) 1.73, 95% CI 0.15–20.02) or length of hospital stay, but was associated with a lower chance of surgery within 24 h of admission (aOR 0.65, 95% CI 0.48–0.90, P = 0.008). A higher Charlson index was independently associated with an over 100% increase in the odds of in-hospital mortality (aOR 2.091, 95% CI 1.53–2.86, P < 0.001). Frail patients paid $15,993 higher in total hospital costs and had a higher likelihood of non-home discharges (aOR 4.29, 95% CI 2.74–6.71, P < 0.001) and peri-operative complications (aOR 1.77, 95% CI 1.14–2.73, P = 0.01).

Conclusion

Frailty was correlated with unfavorable outcomes, except mortality and prolonged hospital stay. Incorporating frailty evaluation into risk models has the potential to enhance patient selection and preparation for urolithiasis intervention.

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Data availability

In compliance with the copyright restrictions set by the AHRQ pertaining to the distribution of HCUP databases, the database utilized in this research will not be made publicly available by the authors. However, all NIS datasets are publicly available through the authorized HCUP central distributor upon request at https://hcup-us.ahrq.gov/tech_assist/centdist.jsp.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

    Fidelis Uwumiro & Victory Okpujie

  2. Department of Surgery, Nnamdi Azikiwe University College of Medicine, Awka, Anambra State, Nigeria

    Festa Madu & Loveth Ezennaya

  3. Royal Cornwall Hospital Treliske Truro, Cornwall, UK

    Olawale Abesin

  4. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Naomi Chigbu

  5. Department of Surgery, Ambrose Alli University, Ekpoma, Edo State, Nigeria

    Cynthia Isuekebhor

  6. Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria

    Oluwatobi Olaomi

  7. St. Barnabas Hospital SBH Health System, Bronx, NY, USA

    Michael Bojerenu

  8. Department of Surgery, Lagos State University College of Medicine, Lagos, Nigeria

    Bolanle Aderehinwo

Authors
  1. Fidelis Uwumiro
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  2. Victory Okpujie
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  3. Festa Madu
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  4. Olawale Abesin
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  5. Naomi Chigbu
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  7. Loveth Ezennaya
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  8. Oluwatobi Olaomi
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  9. Michael Bojerenu
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  10. Bolanle Aderehinwo
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by FU, VO, FM, and OA. FU, VO, NC and CI performed project development. The first draft of the manuscript was written by NC, CI, LE, OO, MB, and BA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fidelis Uwumiro.

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Conflict of interest

The authors declare that they have no relevant financial or non-financial interests to disclose.

Ethical approval for retrospective studies

This study complies with the ethical standards set by the US government through the Agency for Healthcare Research and Quality (AHRQ) which manages and regulates the use of the NIS.

Informed consent

This was a retrospective study based on the Nationwide Inpatient Sample (NIS). The NIS is devoid of both patient and hospital-level identifiers which makes obtaining informed consent impossible. Nonetheless, this study conforms to the standards prescribed by the Agency for Healthcare Research and Quality which manages and regulates the use of the NIS.

Research involving human participants, their data, or biological materials

This research did not involve any human subjects, and no biological material was collected at any stage of the study.

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Uwumiro, F., Okpujie, V., Madu, F. et al. Impact of frailty on clinical outcomes and resource utilization of hospitalizations for renal stone surgery. World J Urol 41, 2519–2526 (2023). https://doi.org/10.1007/s00345-023-04511-y

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  • DOI: https://doi.org/10.1007/s00345-023-04511-y

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