Frailty Is Associated With Postoperative Complications and Device Removal and Revision in Men Undergoing Surgery for...

Our goal was to understand the association between frailty and postoperative complications after artificial urinary sphincter (AUS) and male urethral sling placement.

This was a retrospective study of Medicare beneficiaries undergoing AUS or sling from 2014 to 2016. Baseline frailty was quantified using the Claims-Based Frailty Index (CFI): not frail (<0.15), prefrail (0.15-0.24), and mildly-to-severely frail (≥0.25). Thirty-day complications and device revision/removal were analyzed using generalized linear regression models with log link, Poisson distribution, and robust standard errors.

Altogether, 7252 men underwent surgery: 62.2% AUS and 37.8% sling. Mean age was 74.2 years (SD 5.6 years), and mean CFI was 0.15 (SD 0.05). Thirty-day complications occurred in 15% (N = 1052), and device revision/removal within 1 year occurred in 11% (N = 841). Thirty-day complications were associated with increasing CFI (prefrail adjusted relative risk [aRR] 1.5, mildly-to-severely frail aRR 2.5, compared with not frail, global P = .0001), age (75-84 aRR 1.2, ≥85 aRR 1.4, compared with 66-74, global P = .0007), and Charlson Comorbidity Index (1-3 aRR 1.2, ≥4 aRR 1.8, compared with 0, global P = .0001). Device revision/removal was associated with increasing CFI (prefrail aRR 1.2, mildly-to-severely frail aRR 1.3, compared with not frail global P = .04) and age (75-84 aRR 1.3, ≥85 aRR 1.5, compared with 66-74, global P = .0002), but not Charlson Comorbidity Index (global P = .2).

Frailty, independent of age and comorbidity, was associated with increased odds of 30-day complications and device revision/removal. Thus, frailty, more than comorbidity, is an important yet often unrecognized factor that should be considered during preoperative decision-making for AUS or sling procedures.