Back to Search Start Over

Comparing Frailty Indices for Risk Stratification in Urologic Oncology: Which Index to Choose?

Authors :
Deol ES
Sharma V
Fadel AE
Vasdev R
Henning G
Basourakos S
Ghaffar U
Tollefson MK
Frank I
Houston Thompson R
Karnes RJ
Boorjian SA
Khanna A
Source :
Urology [Urology] 2024 Dec; Vol. 194, pp. 154-161. Date of Electronic Publication: 2024 Aug 28.
Publication Year :
2024

Abstract

Objective: To compare the predictive ability of the modified Frailty Index (mFI) and the revised Risk Analysis Index (RAI-Rev) for perioperative outcomes in patients undergoing major urologic oncologic surgery, aiming to identify the optimal frailty screening tool for surgical risk stratification.<br />Methods: NSQIP was queried to identify patients undergoing radical prostatectomy, partial or radical nephrectomy, or radical cystectomy between 2013 and 2017. We investigated the association of mFI and RAI-Rev with the following 30-day perioperative outcomes using multivariable logistic regression: major complications, Clavien grade ≥4 complications, non-home discharge, 30-day readmission, and all-cause mortality. Receiver-operating characteristic curve analysis compared the predictive performances of the 2 frailty instruments, with differences between the C-statistics assessed using DeLong's test.<br />Results: Among 101,739 patients, 30-day major complication rates varied from 2.40% in prostatectomy to 26.86% in cystectomy, non-home discharge rates ranged from 1.92% to 13.54%, and mortality rates were between 0.16% and 1.43%. RAI-Rev showed higher discriminatory ability for mortality (C-statistic: 0.688-0.798) and non-home discharge (C-statistic: 0.638-0.734) compared to mFI (C-statistic: 0.594-0.677 and 0.593-0.639, respectively). Both frailty indices had similar discriminatory ability for major perioperative complications (C-statistic: 0.531-0.607). DeLong's test confirmed statistically significant differences in C-statistics between RAI-Rev and mFI for mortality (P <.001) and non-home discharge (P <.001) across all surgical cohorts.<br />Conclusion: RAI-Rev may have greater utility as a frailty prognostic tool than mFI among patients undergoing major urologic surgery. Prospective studies and clinical trials exploring frailty should consider these results during trial design.<br />Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest.<br /> (Copyright © 2024. Published by Elsevier Inc.)

Details

Language :
English
ISSN :
1527-9995
Volume :
194
Database :
MEDLINE
Journal :
Urology
Publication Type :
Academic Journal
Accession number :
39214499
Full Text :
https://doi.org/10.1016/j.urology.2024.08.055