Journal article
Comparing Frailty Indices for Risk Stratification in Urologic Oncology: Which Index to Choose?
Urology (Ridgewood, N.J.), Vol.194, pp.154-161
12/01/2024
DOI: 10.1016/j.urology.2024.08.055
PMID: 39214499
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. 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. 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. 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.
Details
- Title: Subtitle
- Comparing Frailty Indices for Risk Stratification in Urologic Oncology: Which Index to Choose?
- Creators
- Ekamjit S. Deol - Mayo Clinic in ArizonaVidit Sharma - Mayo Clinic in ArizonaAnthony E. Fadel - Mayo Clinic in ArizonaRanveer Vasdev - Mayo Clinic in ArizonaGrant Henning - Mayo Clinic in ArizonaSpyridon Basourakos - Mayo Clinic in ArizonaUmar Ghaffar - Mayo Clinic in ArizonaMatthew K. Tollefson - Mayo Clinic in ArizonaIgor Frank - Mayo Clinic in ArizonaR. Houston Thompson - Mayo Clinic in ArizonaRobert J. Karnes - Mayo Clinic in ArizonaStephen A. Boorjian - Mayo Clinic in ArizonaAbhinav Khanna - Mayo Clinic in Arizona
- Resource Type
- Journal article
- Publication Details
- Urology (Ridgewood, N.J.), Vol.194, pp.154-161
- DOI
- 10.1016/j.urology.2024.08.055
- PMID
- 39214499
- NLM abbreviation
- Urology
- ISSN
- 0090-4295
- eISSN
- 1527-9995
- Publisher
- Elsevier
- Number of pages
- 8
- Language
- English
- Date published
- 12/01/2024
- Academic Unit
- Urology
- Record Identifier
- 9984949465502771
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