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Impact of Frailty on Postoperative Outcomes After Sling Surgery
Jessica Dobler, MD1, Sidney Gregorek, BS1, Angelina Kuzina, BS1, Mohammad Mohaghegh, MD1, Garson Chan, MD2.
1University of Vermont Medical Center, Burlington, VT, USA, 2University of Saskatchewan, Saskatoon, SK, Canada.
BACKGROUND: Frailty is a known predictor of postoperative morbidity and poor outcomes, but its impact on outcomes following stress urinary incontinence (SUI) surgery remains unclear. This study aimed to assess the association between frailty and short-term post-operative outcomes among women undergoing surgical treatment for SUI.
METHODS: Female patients with SUI who underwent a primary continence procedure were identified in TriNetX. Frailty was defined using the 5-item Modified Frailty Index (mFI-5), a screening tool designed by the American College of Surgeons National Surgical Quality Improvement Program to determine patient frailty, assigning 1 point for DM, non-independent functional status, CHF, HTN requiring medication, COPD. A score ≥2 indicated frailty. Primary outcomes included 30-day complication rate, 30-day UTI rate, and 90-day readmission rate, compared between frail and non-frail cohorts.
RESULTS: Among 13,288 patients undergoing sling surgery, 9,417 were non-frail and 3,871 were frail (mean age 71.3 vs 72.4 years). Frail patients had higher 30-day UTI rates (9.5% vs 6.8%, p<0.0001), non-UTI complication rates (1.2% vs 0.8%, p=0.0218), and 90-day emergency/inpatient visits (8.0% vs 3.3%, p<0.0001). Frailty was associated with increased risk of postoperative morbidity and postoperative healthcare use.
CONCLUSIONS:Frailty independently predicted higher complication and acute care visit rates after sling surgery. Incorporating frailty screening into preoperative evaluation may improve risk counseling and postoperative management.
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