Presented by: Christopher Connors BA
Icahn School of Medicine at Mount Sinai

Introduction

The modified 5-item frailty index (mFI-5) has been shown to have predictive value for adverse outcomes following various urologic procedures. This study evaluated mFI-5 as a predictor of post-operative outcomes following transurethral resection of bladder tumor (TURBT). 

Materials

The National Surgical Quality Improvement Program database was queried for TURBT cases from 2015-2019. Cases with concurrent major procedures were excluded. mFI-5 scores were calculated by assigning a point to each of the following: COPD, CHF, dependent functional status, hypertension, and diabetes. Patients were stratified by mFI-5 scores. Demographics and 30-day outcomes including Clavien-Dindo (CD) I/II and IV complications, mortality, and increased healthcare resource utilization (HCRU) were compared. HCRU outcomes included prolonged (> 2 days) length of stay (PLOS), unplanned readmission (UR), and discharge to continued care (DCC). Multivariate regression assessed the predictive value of mFI-5 score on outcomes.

Results

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41,109 TURBT cases were identified (mFI-5 = 0: 12,640, mFI-5 = 1: 17,575, mFI-5 = 2: 9,445, mFI-5 ≥ 3: 1,449). Patients with higher mFI-5 scores were more likely to be older, male, White, have higher ASA scores, and have larger tumors, all p < 0.05. Increasing mFI-5 scores resulted in increased frequency of all adverse outcomes, all p < 0.001 [Figure 1]. On multivariate analysis, mFI-5 ≥ 3 classification was a significant predictor of all outcomes including CD I/II (OR = 1.280), CD IV (OR = 2.539), mortality (OR = 2.202), HCRU (OR = 2.094), PLOS (OR = 2.136), DCC (OR = 3.401), and UR (OR = 1.705), all p < 0.05 [Table 1]. A mFI-5 score of 2 was an independent risk factor for HCRU (OR = 1.220), PLOS (OR = 1.224), DCC (OR = 1.770), and UR (OR = 1.176), all p < 0.05. A mFI-5 score of 1 was not a significant predictor for any outcomes studied.

Conclusion

The mFI-5 is an easily ascertainable pre-operative risk assessment tool that is a predictor of adverse clinical and HCRU outcomes following TURBT. 

Funding

None

Lead Authors

Christopher Connors, BA
Icahn School of Medicine at Mount Sinai

Co-Authors

Micah Levy, BS
Icahn School of Medicine at Mount Sinai

Krishna Ravivarapu, MD
Icahn School of Medicine at Mount Sinai

Juan Sebastian Arroyave, BS
Icahn School of Medicine at Mount Sinai

Chih Peng Chin, MD
Icahn School of Medicine at Mount Sinai

Olamide Omidele, MD
Icahn School of Medicine at Mount Sinai

Francisca Larenas, MD
Icahn School of Medicine at Mount Sinai

Michael Palese, MD
Icahn School of Medicine at Mount Sinai