• Prostate Cancer Prostatic Dis. · Dec 2020

    Preoperative frailty predicts adverse short-term postoperative outcomes in patients treated with radical prostatectomy.

    • Giuseppe Rosiello, Carlotta Palumbo, Sophie Knipper, Marina Deuker, Lara Franziska Stolzenbach, Zhe Tian, Giorgio Gandaglia, Nicola Fossati, Francesco Montorsi, Shahrokh F Shariat, Fred Saad, Alberto Briganti, and Pierre I Karakiewicz.
    • Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada. giusepperosiello@hotmail.it.
    • Prostate Cancer Prostatic Dis. 2020 Dec 1; 23 (4): 573-580.

    BackgroundTo investigate the effect of frailty on short-term postoperative outcomes in patients with prostate cancer treated with radical prostatectomy (RP).MethodsWithin the National Inpatient Sample database, we identified 91,618 RP patients treated between 2008 and 2015. The Johns Hopkins Adjusted Clinical Groups frailty-defining indicator was applied, and we examined the rates of frailty over time, as well as its effect on overall complications, major complications, nonhome-based discharge, length of stay (LOS), and total hospital charges (THCs). Time trends and multivariable logistic, Poisson and linear regression models were applied.ResultsOverall, 12,185 (13.3%) patients were frail. Rates of frail patients increased over time (from 10.3 to 18.2%; p < 0.001). Frail patients had higher rates of overall complications (16.6 vs. 8.6%), major complications (4.9 vs. 2.6%), nonhome-based discharge (5.9 vs. 5%), longer LOS (2 vs. 1), and higher THCs ($37,186 vs. $35,241) (all p < 0.001). Moreover, frailty was an independent predictor of overall complications (OR: 1.95), major complications (OR: 1.76), nonhome-based discharge (OR: 1.20), longer LOS (RR: 1.19), and higher THCs (RR: $3160) (all p < 0.001). Of frail patients, 10,418 (85.5%) neither exhibited body mass index ≥ 30 nor Charlson comorbidity index ≥ 2.ConclusionsOn average, every seventh RP patient is frail and that proportion is on the rise. Frail individuals are at higher risk of adverse short-term postoperative outcomes, that cannot be predicted by other risk factors, such as obesity or comorbidities.

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