Frailty as predictor of complications in patients undergoing percutaneous nephrolithotomy (PCNL)

• Published in: World journal of urology Vol. 39; no. 10; pp. 3971 - 3977
• Main Authors: Bhatia, Vinaya P., Aro, Tareq, Smith, Shannon M., Samson, Patrick, Lynch, Elizabeth, Gaunay, Geoffrey, Ren, Ke, Rai, Arun, Mikhail, David, Smith, Arthur, Okeke, Zeph, Hoenig, David M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2021; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Bacteremia; Bacteremia - epidemiology; Blood Loss, Surgical; Clinical trials; Female; Fever - epidemiology; Frailty; Frailty - epidemiology; Hemorrhage; Humans; Intensive Care Units - statistics & numerical data; Kidney Calculi - epidemiology; Kidney Calculi - surgery; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrolithotomy, Percutaneous; Nephrology; Oncology; Original Article; Patients; Phenotypes; Postoperative Complications - epidemiology; Postoperative Hemorrhage - epidemiology; Sepsis; Sepsis - epidemiology; Surgery; Surgical outcomes; Urology; Stone surgery; Frailty; PCNL; Complications
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-021-03681-x

Introduction & Objective
Surgical complications are difficult to predict, despite existing tools. Frailty phenotype has shown promise estimating postoperative risk among the elderly. We evaluate the use of frailty as a predictive tool on patients undergoing percutaneous renal surgery.
Methods
Frailty was prospectively analyzed using the Hopkins Frailty Index, consisting of 5 components yielding an additive score: patients categorized not frail, intermediate, or severely frail. Primary outcomes were complications during admission and 30-day complication rate. Secondary outcomes included overall hospital length of stay (LOS) and discharge location.
Results
A total of 100 patients recruited, of whom five excluded as they did not need the procedure. A total of 95 patients analyzed; 69, 10, and 16 patients were not frail, intermediate, and severely frail, respectively. There were no differences in blood loss, number of dilations, presence of a staghorn calculus, laterality, or location of dilation. Severely frail patients were likely to be older and have a higher American Society of Anesthesiologists score and Charlson comorbidity index. Patients of intermediate or severe frailty were more likely to exhibit postoperative fevers, bacteremia, sepsis, and require ICU admissions (P < 0.05). Frail patients had a longer LOS (P < 0.001) and tended to require skilled assistance when discharge (p < 0.0001).
Conclusions
Frailty assessment appears useful stratifying those at risk of extended hospitalization, septic complications, and need for assistance following percutaneous renal surgery. Risks of sepsis, bacteremia, and post-operative hemorrhage may be higher in frail individuals. Preoperative assessment of frailty phenotype may give insight into treatment decisions and represent a modifiable marker allowing future trials exploring the concept of “prehabilitation”.