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The 5-item frailty index predicts 30-day morbidity and mortality in radical nephrectomy patients: A propensity
Christian Habib Ayoub1, Elia Abou Chawareb1, Abdallah El Kasti1
1Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
Purpose:
To assess the ability of the 5-item frailty index (5-IFi) score to predict 30-day morbidity and mortality post-radical nephrectomy (RN).
Methods:
ACS-NSQIP database was used to select patients who underwent RN from 2011 to 2020. 5-IFi score was calculated by assigning a point for each of the following comorbidities: chronic obstructive pulmonary disease or pneumonia, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were divided into 3 frailty groups 0, 1, and ≥2. Patient demographics, medical comorbidities, prolonged length of stay, and prolonged operative time were compared between different groups; mortality and morbidity using the Clavien-Dindo classification (CVD). Multivariable logistic regression models and propensity score matching were performed as a sensitivity analysis to control for possible confounders.
Results:
Cohort consisted of 36,682 patients whereby 5-IFi class 0, 1, and ≥2 included 11,564 (31.5%), 16,571 (45.2%), and 8,547 (25.3%) patients respectively. A multivariable analysis and propensity score matching revealed that patients with 5-IFi classes 1 and ≥ 2 were more likely to have a prolonged length of stay (OR = 1.11, 1.3, respectively) and to mortality (OR = 1.85 for frailty class ≥2); in addition to CVD class 1 & 2 (OR = 1.51, OR = 1.13, respectively), and CVD ≥ 4 (OR = 1.41, 1.86, respectively) as compared to 5-IFi class 0 (P < 0.001).
Conclusion:
The 5-IFi score was found to be an independent predictor of prolonged length of stay, morbidity, and mortality after RN. This tool can play a major role in preoperative risk assessment and patient counseling based on individualized risks.
Insights
The 5-item frailty index (5-IFi) score effectively predicts prolonged hospital stays, morbidity, and mortality after radical nephrectomy (RN). This tool aids in preoperative risk assessment for patients undergoing RN.
Area of Science:
- Urology
- Surgical Oncology
- Geriatrics
Background:
- Radical nephrectomy (RN) is a major surgery with potential for significant postoperative complications.
- Accurate preoperative risk stratification is crucial for optimizing patient outcomes after RN.
Purpose of the Study:
- To evaluate the predictive capability of the 5-item frailty index (5-IFi) score for 30-day morbidity and mortality following radical nephrectomy.
- To determine if the 5-IFi score can identify patients at higher risk for adverse events post-RN.
Main Methods:
- Utilized the ACS-NSQIP database (2011-2020) for patients undergoing RN.
- Calculated the 5-IFi score based on comorbidities: COPD/pneumonia, CHF, functional status, hypertension, and diabetes.
- Compared outcomes (morbidity via Clavien-Dindo, mortality, prolonged LOS) across frailty groups (0, 1, ≥2) using multivariable regression and propensity score matching.
Main Results:
- The cohort included 36,682 patients; 31.5% had 5-IFi 0, 45.2% had 5-IFi 1, and 25.3% had 5-IFi ≥2.
- Higher 5-IFi scores (1 and ≥2) were significantly associated with prolonged length of stay (OR 1.11-1.3) and increased mortality (OR 1.85 for ≥2).
- Elevated 5-IFi scores also correlated with higher Clavien-Dindo morbidity grades (OR 1.13-1.86) compared to the non-frail group (P < 0.001).
Conclusions:
- The 5-item frailty index (5-IFi) score is an independent predictor of prolonged stay, morbidity, and mortality after radical nephrectomy.
- The 5-IFi score serves as a valuable tool for preoperative risk assessment in RN patients.
- Individualized patient counseling regarding risks can be enhanced using the 5-IFi score.
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