Transurethral Resection of Bladder Tumor Outcomes Are Predicted by a 5-Item Frailty Index

Christopher Connors; Daniel Wang; Micah Levy; Krishna T Ravivarapu; Chih Peng Chin; Juan Sebastian Arroyave; Olamide Omidele; Francisca Larenas; Michael Palese

doi:10.1016/j.urology.2024.03.026

Transurethral Resection of Bladder Tumor Outcomes Are Predicted by a 5-Item Frailty Index

Urology. 2024 Mar 24:S0090-4295(24)00201-2. doi: 10.1016/j.urology.2024.03.026. Online ahead of print.

Authors

Christopher Connors¹, Daniel Wang², Micah Levy², Krishna T Ravivarapu², Chih Peng Chin², Juan Sebastian Arroyave², Olamide Omidele², Francisca Larenas², Michael Palese²

Affiliations

¹ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: christopher.connors@icahn.mssm.edu.
² Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.

PMID: 38522634
DOI: 10.1016/j.urology.2024.03.026

Abstract

Objective: To evaluate the mFI-5 as a predictor of postoperative outcomes following transurethral resection of bladder tumor (TURBT).

Methods: The National Surgical Quality Improvement Program database was queried for TURBT cases from 2015-2019. mFI-5 scores were calculated by assigning a point to chronic obstructive pulmonary disease, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were stratified by mFI-5 scores. Demographics and 30-day outcomes including Clavien-Dindo (CD) complications, mortality, and increased healthcare resource utilization (HCRU) were compared. HCRU outcomes included prolonged length of stay, unplanned readmission, and discharge to continued care. Multivariate regression assessed the predictive value of mFI-5 scores on outcomes.

Results: 40,278 TURBT cases were identified (mFI-5 =0: 12,400, mFI-5 =1: 17,328, mFI-5 =2: 9225, mFI-5 ≥3: 1416). Patients with higher mFI-5 scores were more likely to be older, male, White, and have larger tumors, all P < .05. Increasing mFI-5 scores resulted in increased frequency of all adverse outcomes, all P < .001. On multivariate analysis, mFI-5 ≥ 3 classification was a predictor of CD I/II (OR=1.280), CD IV (OR=2.539), mortality (OR=2.202), HCRU (OR=2.094), prolonged length of stay (OR=2.136), discharge to continued care (OR=3.401), and unplanned readmission (OR=1.705), all P < .05. A mFI-5 ≥ 3 demonstrated a sensitivity ranging from 6.0%-13.5% and a specificity ranging from 96.6%-97.0% for all outcomes.

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