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Association of Preoperative Frailty and Postoperative Morbidity Among Patients Undergoing Urinary Diversion for Refractory Lower Urinary Tract Dysfunction
John Ernandez, MD1, Vanessa Lukas, MD1, Juntao Yu, PhD2, Yu Zheng, MD1.
1Department of Urology, Brigham and Women's Hospital, Boston, MA, USA, 2Whitehead Institute for Biomedical Research, Howard Hughes Medical Institute, Cambridge, MA, USA.
Background: While urinary diversion for refractory lower urinary tract dysfunction (LUTD) can improve quality of life, diversion carries substantial risk of complication. We sought to characterize preoperative frailty and its association with postoperative morbidity among patients undergoing diversion for LUTD.
Methods: We identified 64 adults who underwent urinary diversion for benign indications from 2010 to present at our institution. Preoperative markers of frailty included the Modified Frailty Index (mFI-11), psoas muscle index (PMI = cross-sectional area of psoas muscles at L3 [cm
2]/ height
2 [m
2]), and serum albumin. Our primary endpoint was clinically significant 90-day complications. 30-day readmission, ED presentations, transfusion, and overall mortality were also assessed. Associations were determined via multivariable logistic or linear regression (
p < 0.05 as statistically significant).
Results: 70% of patients had intermediate or higher comorbidity (mCCI ≥ 3) and 52% met criteria for severe frailty (mFI ≥ 0.27). 55% developed clinically significant complications requiring readmission and/or intervention within 90 days of discharge from index diversion; commonly, complications were infectious (45%) or wound-related (21%). Overall mortality at time of data accrual was 19%. Severe frailty as well as lower PMI and serum albumin were each independently associated with 90-day complications. Severe frailty and lower serum albumin were also independently associated with 30-day blood transfusions.
Conclusions: Patients undergoing diversion for LUTD frequently have significant baseline frailty. Preoperative frailty markers, including albumin and PMI, are associated with post-diversion morbidity independent of comorbidity, highlighting the need for assessing preoperative frailty prior to pursuing diversion for benign disease.
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