Comparing mFI-5, ASA Class, and mCCI as Predictors of Postoperative Outcomes Following Endoscopic Treatment of BPH

While many risk indexes for predicting morbidity following urological surgery have been reported, determining the best ones for clinical use is challenging. A new frailty index (mFI-5) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH), but its effectiveness for predicting postoperative complications has not been investigated. We compared mFI-5 with the two most commonly used indexes, the American Society of Anesthesiologists (ASA) physical classification and the modified Charlson Comorbidity Index (mCCI), and the total number of comorbidities using the National Surgical Quality Improvement Program (NSQIP) database. We retrospectively queried the 2015-2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using Current Procedural Terminology and International Classification of Diseases codes. Patients were stratified by procedure type (transurethral resection of prostate [TURP], laser vaporization of prostate [LVP], laser enucleation of prostate [LEP]). Risk indexes were calculated and compared as predictors of postoperative using logistic regression and C-statistics. 38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%. When stratifying based on surgery type, the complication rates were 11.0% for TURP, 10.3% for LVP, and 7.6% for LEP. Discriminatory ability of risk indexes was mostly comparable between risk indexes but differed based on procedure type and postoperative outcome. mCCI was found to be superior in predicting surgical complications for TURP and in predicting unplanned reoperation and increased length of stay for LVP. ASA Class was found to be superior in predicting all-cause complication, unplanned reoperation, and complication for LEP. mFI-5 was not superior to any index in predicting any postoperative outcome. mCCI and ASA Class have utility in predicting postoperative outcomes for LVP and LEP, respectively. Most risk indexes are comparable and therefore can be utilized at the ease of the provider.