title: Preoperative frailty predicts postoperative complications and mortality in urology patients.
abstract: OBJECTIVE
  Our objective was to determine the impact of preoperative frailty, as measured by validated Risk Analysis Index (RAI), on the occurrence of postoperative complications after urologic surgeries in a national database comprised of diverse practice groups and cases.
  
  
  METHODS
  The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2011 for a list of abdominal, vaginal, transurethral and scrotal urological surgeries using Current Procedural Terminology codes. The study population was subdivided into two groups based on the nature of procedures performed: complex procedures (inpatient) and simple procedures (outpatient). Risk Analysis Index score was calculated using preoperative NSQIP variables to determine preoperative frailty. Major postoperative morbidities (pulmonary, cardiovascular, renal and infectious), mortality, return to operating room, discharge destination and readmission to the hospital were examined.
  
  
  RESULTS
  The study identified 42,715 patients who underwent urological procedures, 25,693 complex and 17,022 simple procedures. Mean RAI score (range) was 7.75 (0-53). The majority of patients scored low on the RAI (90.57 % with RAI < 10). As the RAI score increased, there was a significant increase in postoperative complication and mortality rate (both p < 0.0001). Similarly, the rate of return to operating room and hospital readmission rate increased as RAI increased (both p < 0.0001). Additionally, rate of discharge to home decreased. Interestingly, mortality rate in patients with high RAI did not differ comparing simple to complex procedures (p = 0.90), whereas complications were significantly greater in the complex operation (p = 0.01).
  
  
  CONCLUSIONS
  Increase in frailty, as measured by RAI score, is associated with increased postoperative complications and mortality. RAI may allow for rapid identification and counseling of patients who are at high risk of adverse perioperative outcomes.
authors.affiliation: Division of Urology, University of Nebraska Medical Center, 984110 Nebraska Medical Center, Omaha, NE, 68198-4110, USA. isharwal.sudhir@gmail.com.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Isharwal
authors.affiliation: Division of Vascular Surgery, University of Nebraska Medical Center, Omaha, NE, USA.|Department of Surgery, Veterans Administration Medical Center, Omaha, NE, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johanning
authors.affiliation: Division of Urology, University of Nebraska Medical Center, 984110 Nebraska Medical Center, Omaha, NE, 68198-4110, USA.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Dwyer
authors.affiliation: Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Kendra K
authors.initials: KK
authors.lastname: Schimid
authors.affiliation: Division of Urology, University of Nebraska Medical Center, 984110 Nebraska Medical Center, Omaha, NE, 68198-4110, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: LaGrange
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013520:Urologic Surgical Procedures / Q000009:adverse effects*
keywords: Complications; Frailty; Mortality; NSQIP; Risk Analysis Index