Hypogonadism, frailty, and postoperative outcomes among men undergoing partial nephrectomy

To determine the prevalence of hypogonadism in men undergoing partial nephrectomy (PN) and whether hypogonadism and frailty are associated with adverse postoperative outcomes.

We identified men undergoing PN between 2012-2021 using the Merative Marketscan database. Patients were considered to have hypogonadism if diagnosed within 5 years prior to PN. Frailty was determined using the Hospital Frailty Risk Score (HFRS). Length of stay (LOS), complications, ED visits, and inpatient readmissions were compared. Sub-group analysis of men with hypogonadism was performed to determine if testosterone replacement therapy (TRT) improved clinical outcomes.

Among 9,105 men who underwent PN, 809 (8.9%) were hypogonadal prior to PN. Hypogonadal men were significantly more frail compared to eugonadal men (HFRS score: median 6.7, IQR 4.1-10.1 vs. median 5.6, IQR 3.3-8.8, p < 0.001). However, there was no significant difference in LOS following PN nor in 90-day postoperative complications, ED visits, or inpatient readmission between men with and without hypogonadism. However, intermediate- and high-risk frailty were associated with increased risk of 90-day ED visits and 90-day inpatient readmission compared to low-risk patients. Among high-risk men with hypogonadism, TRT was associated with decreased risk of 90-day ED visits (p = 0.04).

Frailty was associated with postoperative outcomes following PN. Hypogonadism was associated with frailty, and treatment of hypogonadal men with TRT was associated with reduction in post-operative risk. These findings suggest a role for frailty assessment, and possibly testosterone screening, in men undergoing PN.