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Prospective geriatric assessment for perioperative risk stratification in partial nephrectomy
M F Wunderle1, N Härtel2, N Wagener3
1Department of Urology and Urological Surgery, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Summary
Preoperative frailty assessment, including the Geriatric Assessment in Partial Nephrectomy (GAPN) score, predicts major complications and Trifecta failure after partial nephrectomy (PN). This aids in surgical planning and patient selection.
Area of Science:
- Nephrology
- Geriatric Medicine
- Surgical Outcomes
Background:
- Comorbidities and frailty significantly influence surgical outcomes.
- Partial nephrectomy (PN) is a common procedure for kidney tumors.
- Predicting postoperative outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate frailty and comorbidity measures in predicting postoperative outcomes after PN.
- To identify key frailty parameters for risk stratification.
- To develop a practical tool for clinical use.
Main Methods:
- Prospective analysis of 150 patients undergoing PN (2015-2018).
- Assessment of frailty and comorbidities.
- Primary endpoint: major postoperative complications (MPC).
- Secondary endpoints: Trifecta failure and hospital readmissions.
- Development of the Geriatric Assessment in Partial Nephrectomy (GAPN) score.
Main Results:
- Increased frailty indices (Hopkins ≥2, Groningen ≥4) correlated with higher MPC risk.
- Poor physical performance (low handgrip strength, short Full-Tandem-Stand time) predicted MPC and Trifecta failure.
- The GAPN score (≥3) significantly predicted MPC and Trifecta failure in multivariable analysis.
Conclusions:
- Frailty and comorbidities are critical determinants of postoperative course after PN.
- Preoperative assessment of these factors is essential for treatment planning.
- The GAPN score shows promise as a tool for predicting outcomes in PN patients.
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