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

Prostate Cancer and Prostatic Diseases volume 23, pages 573–580 (2020)Cite this article

Subjects

Abstract

Background

To investigate the effect of frailty on short-term postoperative outcomes in patients with prostate cancer treated with radical prostatectomy (RP).

Methods

Within 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.

Results

Overall, 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.

Conclusions

On 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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Fig. 1: Venn diagram.
Fig. 2: Time trends.

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Code availability

The data that support the findings of this study are openly available in the Surveillance, Epidemiology, and End Results Program at https://seer.cancer.gov.

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Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada

    Giuseppe Rosiello, Carlotta Palumbo, Sophie Knipper, Marina Deuker, Lara Franziska Stolzenbach, Zhe Tian, Fred Saad & Pierre I. Karakiewicz

  2. Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy

    Giuseppe Rosiello, Giorgio Gandaglia, Nicola Fossati, Francesco Montorsi & Alberto Briganti

  3. Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy

    Carlotta Palumbo

  4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Sophie Knipper & Lara Franziska Stolzenbach

  5. Department of Urology, University Hospital Frankfurt, Frankfurt, Germany

    Marina Deuker

  6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  7. Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia

    Shahrokh F. Shariat

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  1. Giuseppe Rosiello
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Correspondence to Giuseppe Rosiello.

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Rosiello, G., Palumbo, C., Knipper, S. et al. Preoperative frailty predicts adverse short-term postoperative outcomes in patients treated with radical prostatectomy. Prostate Cancer Prostatic Dis 23, 573–580 (2020). https://doi.org/10.1038/s41391-020-0225-3

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