Abstract
Frailty is defined as decreased physiological reserve throughout multiple organ systems. With an increasing rate of elective operations in the aging population, the outcome of surgery on frail patients has become important. We aimed to determine if “frailty” predicts surgical complications according to Clavien-Dindo classification after urological surgeries in elderly patients. After ethical committee approval, records of the patients who had undergone transurethral resection of the prostate and bladder, radical or partial nephrectomy, and radical prostatectomy were detected. Frailty was classified using a 15-point validated scale as modified frailty index (mFI). Patients with a score of 3 or more were classified as frail, 1, 2 were intermediately frail, and 0 were non-frail. Main outcome measures were 30-day surgical complications according to Clavien-Dindo classification and length of stay (LOS) at hospital. A total of 250 patients were queried. The mean age of the patients was 73.2 ± 6.26. In the mFI = 2 and mFI ≥ 3 groups, Clavien-Dindo grade III ratio was significantly higher than the mFI = 0 and mFI = 1 groups. Therefore, as the level of the mFI increased, so did the Clavien-Dindo grade. LOS at the hospital in mFI ≥ 3 group was significantly higher than other groups. In conclusion, increased mFI scores are associated with worsened surgical outcomes and prolonged LOS in elderly patients undergoing urological operations. The findings of our study showed that a 15-point mFI assessment may be useful for predicting surgical postoperative adverse complications in patients over 65 years of age undergoing urological malignancy surgeries.
Similar content being viewed by others
References
Cui HW, Turney BW, Griffiths J (2017) The preoperative assessment and optimization of patients undergoing major urological surgery. Curr Urol Rep 18:. https://doi.org/https://doi.org/10.1007/s11934-017-0701-z
Townsend NT, Robinson TN (2015) Surgical risk and comorbidity in older urologic patients geriatric surgery frailty preoperative risk assessment. Clin Geriatr Med 31:591–601. https://doi.org/https://doi.org/10.1016/j.cger.2015.06.009
Saricaoğlu F, Aksoy ŞM, Yilmazlar A, et al (2018) Predicting mortality and morbidity of geriatric femoral fractures using a modified frailty index and perioperative features: a prospective, multicentre and observational study. Turk Geriatr Derg 21:118–127. https://doi.org/https://doi.org/10.31086/tjgeri.2018240413
Silverstein JH, Rooke GA, Reves JG, McLeskey CH (2018) Geriatric anesthesiology, Third edit. Springer International Publishing, Cham
Ferrucci L, Williamson JD, Darer J, et al (2011) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. Journals Gerontol Ser A Biol Sci Med Sci 59:M255–M263. https://doi.org/https://doi.org/10.1093/gerona/59.3.m255
Arya S, Filson CP, Patil D, et al (2017) Patient frailty and discharge disposition following radical cystectomy. Clin Genitourin Cancer 15:e615–e621. https://doi.org/https://doi.org/10.1016/j.clgc.2016.12.013
Lascano D, Pak JS, Kates M, et al (2015) Validation of a frailty index in patients undergoing curative surgery for urologic malignancy and comparison with other risk stratification tools. Urol Oncol Semin Orig Investig 33:426.e1–426.e12. https://doi.org/https://doi.org/10.1016/j.urolonc.2015.06.002
Afilalo J, Mottillo S, Eisenberg MJ, et al (2012) Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes 5:222–228. https://doi.org/https://doi.org/10.1161/CIRCOUTCOMES.111.963157
Dal Moro F, Morlacco A, Motterle G, et al (2017) Frailty and elderly in urology: is there an impact on post-operative complications? Cent Eur J Urol 70:197–205. https://doi.org/https://doi.org/10.5173/ceju.2017.1321
Robinson TN, Eiseman B, Wallace JI, et al (2012) Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72:1526–1531. https://doi.org/https://doi.org/10.1097/TA.0b013e3182542fab
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 240:205–213
Tajar A, Lee DM, Han TS, et al (2013) The ability of three different models of frailty to predict all-cause mortality: results from the European Male Aging Study (EMAS). Arch Gerontol Geriatr 57:360–368. https://doi.org/https://doi.org/10.1016/j.archger.2013.06.010
Green P, Woglom AE, Genereux P, et al (2012) The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv 5:974–981. https://doi.org/https://doi.org/10.1016/j.jcin.2012.06.011
Tan KY, Kawamura YJ, Tokomitsu A, Tang T (2012) Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 204:139–143. https://doi.org/https://doi.org/10.1016/j.amjsurg.2011.08.012
Kenig J, Zychiewicz B, Olszewska U, et al (2015) Six screening instruments for frailty in older patients qualified for emergency abdominal surgery. Arch Gerontol Geriatr 61:437–442. https://doi.org/https://doi.org/10.1016/j.archger.2015.06.018
Kim SW, Han HS, Jung HW, et al (2014) Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg 149:633–640. https://doi.org/https://doi.org/10.1001/jamasurg.2014.241
Partridge JSL, Fuller M, Harari D, et al (2015) Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg 18:57–63. https://doi.org/https://doi.org/10.1016/j.ijsu.2015.04.037
Suskind AM, Walter LC, Jin C, et al (2016) The impact of frailty on complications in patients undergoing common urologic procedures; a study from the American College of Surgeons National Surgical Quality Improvement Database. 117:836–842. https://doi.org/https://doi.org/10.1111/bju.13399.
Jammer I, Wickboldt N, Sander M, et al (2015) Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measur. Eur J Anaesthesiol 32:88–105. https://doi.org/https://doi.org/10.1097/EJA.0000000000000118
Lin HS, McBride RL, Hubbard RE (2018) Frailty and anesthesia – risks during and post-surgery. Local Reg. Anesth. 11:61–73
Krishnan M, Beck S, Havelock W, et al (2014) Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing 43:122–126. https://doi.org/https://doi.org/10.1093/ageing/aft084
Agarwal R (2016) Defining end-stage renal disease in clinical trials: a framework for adjudication. Nephrol Dial Transplant 31:864–867. https://doi.org/https://doi.org/10.1093/ndt/gfv289
Fau M, Guilera N, Bover J, et al (2014) Preoperative estimated glomerular filtration rate and the risk of major adverse cardiovascular and cerebrovascular events in non-cardiac surgery ‡. Br J Anaesth 113:644–651. https://doi.org/https://doi.org/10.1093/bja/aeu134
Purvis TE, Kessler RA, Boone C, et al (2017) The effect of renal dysfunction on short-term outcomes after lumbar fusion. Clin Neurol Neurosurg 153:8–13. https://doi.org/https://doi.org/10.1016/j.clineuro.2016.12.002
Revenig LM, Ogan K, Guzzo TJ, Canter DJ (2014) The use of frailty as a surgical risk assessment tool in elderly patients. Curr Geriatr Reports 3:1–7. https://doi.org/https://doi.org/10.1007/s13670-013-0068-z
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
ESM 1
(PDF 165 kb)
Rights and permissions
About this article
Cite this article
Korkmaz Toker, M., Altıparmak, B., Uysal, A.I. et al. The Impact of Preoperative Frailty on Postoperative Complications in Elderly Patients Undergoing Urological Malignancy Surgery. Indian J Surg 82, 421–426 (2020). https://doi.org/10.1007/s12262-019-01936-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-019-01936-x