title: Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity.
abstract: To evaluate the association between frailty and postoperative discharge destination after different types of commonly performed urologic procedures in older patients.
  
  
  
  Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2011 to 2013, we identified commonly performed inpatient urologic procedures among patients aged 65 and older. We then assessed the effect of frailty, measured by the NSQIP Frailty Index (NSQIP-FI), on discharge to a skilled or assisted living facility using logistic regression and assessed the heterogeneity of this effect across procedures using 2-level random effects modeling.
  
  
  
  Overall, 1144 out of 20,794 (5.5%) urologic cases, representing 19 different procedures, resulted in discharge to a skilled or assisted living facility. Cystectomy and large transurethral resection of bladder tumor had the highest percentage (16.3%). Twenty-five percent of patients undergoing urology procedures were frail (NSQIP-FI 0.18+), including 9.8% of patients discharged to a facility. Even after adjustment for year, age, race, type of anesthesia, smoking status, recent weight loss, and whether or not the procedure was elective, frailty was strongly associated with discharge to a facility (adjusted odds ratio 3.1 [96% confidence interval 2.5, 3.8] for NSQIP-FI 0.18+ compared to NSQIP FI 0). This finding was consistent across most procedures of varying complexity with an overall effect of odds ratio 1.6 (95% confidence interval 1.5, 2.0).
  
  
  
  Increasing frailty is associated with discharge to a skilled or assisted living facility across most inpatient urologic procedures evaluated, regardless of complexity. This information is important for preoperative counseling with patients undergoing urologic surgery.
authors.affiliation: Department of Urology, University of California, San Francisco, CA. Electronic address: Anne.Suskind@ucsf.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.affiliation: Division of Geriatrics, University of California, San Francisco, CA.
authors.forename: Chengshi
authors.initials: C
authors.lastname: Jin
authors.affiliation: Department of Urology, University of California, San Francisco, CA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: Department of General Surgery, University of California, San Francisco, CA.
authors.forename: Emily
authors.initials: E
authors.lastname: Finlayson
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.affiliation: Department of Preventative Medicine, University of Tennessee Health Science Center.
authors.forename: Saunak
authors.initials: S
authors.lastname: Sen
authors.affiliation: Division of Geriatrics, University of California, San Francisco, CA.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D000073496:Frailty / Q000150:complications*; D006801:Humans; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States; D013520:Urologic Surgical Procedures