Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study

Suskind, Anne M.; Jin, Chengshi; Walter, Louise C.; Finlayson, Emily

doi:10.1016/j.juro.2016.12.001

Cited by 43 publications

(44 citation statements)

References 15 publications

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“…urinary tract infection [UTI], superficial wound infection, pneumonia or blood transfusion) or major (e.g. hospital readmission, return to the operating room, sepsis, deep vein thrombosis [DVT], CVA, reintubation, renal failure, myocardial infarction, pulmonary embolus, dehiscence, cardiac arrest, deep wound infection, coma or death] in accordance with previous studies examining complications using these data [2,7,8,12,15–16].…”

Section: Methodssupporting

confidence: 82%

“…Several frailty indices have been developed to objectively improve upon the ability to predict postoperative complications among older patients, however, there is a lack of consensus on which index to use. Many studies use the NSQIP frailty index (NSQIP-FI) [2,12–16], which is a well-known 11-item cumulative deficits model developed from the 70-item questionnaire from the Canadian Study on Health and Aging. In response to recent changes in ACS-NSQIP variables and a desire to simplify frailty measurement [17,18], other modified frailty indices have been developed including the simplified Frailty Index (sFI) [8,19] and the Risk Analysis Index (RAI) [7].…”

Section: Introductionmentioning

confidence: 99%

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“A National Study Demonstrating the Need for Improved Frailty Indices for Preoperative Risk Assessment of Common Urologic Procedures”

Amin

Lee

Jin

et al. 2019

Urology

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Objective: To compare the associations between frailty indices and postoperative complications among older adults undergoing common urologic procedures. Frailty is known to be strongly associated with poor postoperative complications; however, the optimal way to measure frailty remains unknown. Methods: We identified the 20 most common urologic procedures from 2013–2016 in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Frailty was measured using the NSQIP frailty index (NSQIP-FI), simplified frailty index (sFI), and Risk Analysis Index (RAI). Multivariable logistic regression models were performed with each index and the American Society of Anesthesiologists (ASA) classification system with postoperative complications (any, major, or minor) as the outcomes. Statistical models were compared using the following fit parameters: area under the curve (AUC), Akaike information criterion (AIC) and Bayesian information criterion (BIC). Results: A total of 158,855 procedures were identified. All frailty indices (i.e., NSQIP-FI, sFI, and RAI) and ASA were associated with increased odds for any, major, and minor complications (all p-values <0.001). ASA demonstrated stronger model fit parameters for any, major, and minor complications compared to all other indices, with an AUC of 0.63, 0.64, and 0.64, respectively (all p-values <0.001). Adding ASA to each frailty index resulted in slight improvement of model fit parameters (p-value <0.001). Conclusions: ASA slightly outperforms current frailty indices in predicting postoperative complications among individuals undergoing commonly performed urologic procedures. Our findings highlight the need for improved frailty measures for preoperative risk assessment.

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Section: Methodssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

“A National Study Demonstrating the Need for Improved Frailty Indices for Preoperative Risk Assessment of Common Urologic Procedures”

Amin

Lee

Jin

et al. 2019

Urology

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“…14,18 We also found an association between increased frailty and higher complications in pelvic organ prolapse surgery. 19 This study is novel in that it investigates the role of frailty specifically with regard to AUS surgery. We found that increased frailty (and not age) was associated with major complications, while age (and not frailty) was associated with minor complications.…”

Section: Discussionmentioning

confidence: 99%

“…For the purposes of this study, we categorized frailty into the following ascending categories: 0, 0.09, 0.18, or ≥0.27 consistent with the literature. 19 The NSQIP-FI specifically assesses frailty and has been shown to correlate well with morbidity and mortality in surgical subspecialties including Urology. 14,20 Additional covariates obtained from NSQIP data included demographic information such as patient age in years (categorized as <65, 65-74, 75-84, ≥85), race (white and non-white), and body mass index (BMI) (underweight [<18.5], normal [18.5-24.9], overweight [25-29.9], and obese [≥30]).…”

Section: Covariatesmentioning

confidence: 99%

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

Medendorp

Anger

Jin

et al. 2019

Urology

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Objectives: To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure. Methods: This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006-2013. Frailty was quantified using the NSQIP-FI (Frailty Index) and was applied to logistic regression models predicting 30-day complications (overall, major and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure). Results: We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% CI 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% CI 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, p<0.01). Conclusions: Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.

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“…Reconstructive surgery is the mainstay of treatment for symptomatic pelvic organ prolapse,1 and most surgery is performed transvaginally 2. Prolapse can arise from an isolated segment of the vagina but typically involves several vaginal segments.…”

Section: Introductionmentioning

confidence: 99%

Preoperative POPQ versus Simulated Apical Support as a Guideline for Anterior or Posterior Repair at the Time of Transvaginal Apical Suspension (PREPARE trial): study protocol for a randomised controlled trial

et al. 2020

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IntroductionTransvaginal reconstructive surgery is the mainstay of treatment for symptomatic pelvic organ prolapse. Although adequate support for the vaginal apex is considered essential for durable surgical repair, the optimal management of anterior and posterior vaginal wall prolapse in women undergoing transvaginal apical suspension remains unclear. The objective of this trial is to compare surgical outcomes of pelvic organ prolapse quantification (POPQ)-based surgery with outcomes of simulated apical support-based surgery for anterior or posterior vaginal wall prolapse at the time of transvaginal apical suspension.Methods and analysisThis is a randomised, multicentre, non-inferiority trial. While women who are assigned to the POPQ-based surgery group will undergo anterior or posterior colporrhaphy for all stage 2 or greater anterior or posterior vaginal prolapse, those assigned to simulated apical support-based surgery will receive anterior or posterior colporrhaphy only for the prolapse unresolved under simulated apical support. The primary outcome measure is the composite surgical success, defined as the absence of anatomical (anterior or posterior vaginal descent beyond the hymen or descent of the vaginal apex beyond the half-way point of vagina) or symptomatic (the presence of vaginal bulge symptoms) recurrence or retreatment for prolapse by either surgery or pessary, at 2 years after surgery. Secondary outcomes include the rates of anterior or posterior colporrhaphy, the changes in anatomical outcomes, condition-specific quality of life and sexual function, perioperative outcomes and adverse events.Ethics and disseminationThis study was approved by the institutional review board of each participating centre (Seoul National University College of Medicine/Seoul National University Hospital, Chonnam National University Hospital, Seoul St. Mary’s Hospital, International St. Mary’s Hospital). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.Trial registration numberNCT03187054

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Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study

Cited by 43 publications

References 15 publications

“A National Study Demonstrating the Need for Improved Frailty Indices for Preoperative Risk Assessment of Common Urologic Procedures”

“A National Study Demonstrating the Need for Improved Frailty Indices for Preoperative Risk Assessment of Common Urologic Procedures”

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

Preoperative POPQ versus Simulated Apical Support as a Guideline for Anterior or Posterior Repair at the Time of Transvaginal Apical Suspension (PREPARE trial): study protocol for a randomised controlled trial

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