Presented by: Justin James BS
CUNY School of Medicine

Introduction

While studies have reported many risk indexes for predicting morbidity following urological surgery, it is difficult to determine which risk indexes are better utilized in the clinical space. A new frailty index (modified Frailty Index-5(mFI-5)) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH); however, its discriminatory abilities for postoperative complications has not been investigated. Therefore, we compared mFI-5 to two most commonly used indexes, the American Society of Anesthesiologists physical classification (ASA) and modified Charlson Comorbidity Index (mCCI), and total number of comorbidities using the National Surgical Quality Improvement Program (NSQIP) database.

Materials

We retrospectively queried the 2015-2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using CPT and ICD codes. Patients were stratified by procedure type (transurethral resection of the prostate (TURP), laser vaporization (LVP) and enucleation (LEP) of the prostate). Risk indexes were calculated and compared as predictors of postoperative outcomes (all cause complication, surgical/medical complications, unplanned reoperation, unplanned readmission, length of stay, and complication severity) using logistic regressions and C-statistics (AUC).

Results

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38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%, but upon stratifying by procedure, the complication rates were 11.0%, 10.3%, and 7.6% for TURP, LVP, and LEP, respectively. Discriminatory ability of risk indexes was mostly comparable between risk indexes but differed based on procedure type and postoperative outcome. mCCI was found to be superior in predicting surgical complications for TURP, and in predicting unplanned reoperation and increased length of stay for LVP. ASA Class was found to be superior in predicting all cause complication, unplanned reoperation, and complication for LEP. mFI-5 was not superior to any index in predicting any postoperative outcome.

Conclusion

mCCI and ASA Class have utility in predicting postoperative outcomes for LVP and LEP, respectively. Most risk indexes are comparable and therefore can be utilized at the ease of the provider.

Funding

None.

Co-Authors

Grace Jun, BS
Smith Institute of Urology

Jacob Gaines, MD
SUNY Downstate

Zeph Okeke, MD
Smith Institute for Urology

Gregory Mullen, MD
Smith Institute for Urology

Arun Rai, MD, MBA, MSc
Smith Institute for Urology