Frailty Among Bladder Augmentation Patients: Healthcare Utilization and Perioperative Outcomes

To study the impact of frailty on healthcare utilization in patients undergoing benign pelvic reconstructive surgery; specifically, bladder augmentation.

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for adults undergoing bladder augmentation between 2005 and 2022. The Five-Item Frailty Index (FFI) was used to assign a score from 0 to 6. Healthcare resource utilization (HRU) was defined by 4 metrics: prolonged length of stay (PLOS), 30-day postoperative readmissions (AR), discharge to continued care (ie, non-home location) (DCC), overall HRU which is a composite of the other 3 outcomes, and complications. Multivariable risk-adjusted regression models were generated.

Three hundred sixty-four patients were included, the majority being white (71%), female (52%), with a median age of 49 years. After controlling for baseline variables, higher FFI score (≥2) was independently associated with PLOS (OR 1.90 [1.02-3.53], P = .04), DCC (OR 2.76 [1.24-6.15], P = .01), and greater overall HRU (OR 2.64 [1.29-5.40], P = .008) but not AR (OR 2.27 [0.99-5.19], P = .05). Higher frailty (FFI ≥2) was independently associated with experiencing any complication (OR 2.32 [1.16-4.64], P = .02) as well as major complications (Clavien ≥3) (OR 2.56 [1.15-5.7] P = .02).

Frail adults undergoing bladder augmentation experience greater HRU and complications. This highlights the importance of frailty in benign pelvic reconstructive surgery and stresses the need for interventions to optimize frail patients.