Mp10-12 comparison Between the Asa Score and the Modified Frailty Index (Mfi) in Urologic Oncological and Non Oncological Urological Interventional Procedures

Abstract

INTRODUCTION AND OBJECTIVES: Elderly patients are a vulnerable population at increased risk for treatment-related toxicity. Almost 25% of the urological population is older than 75 years. Methods to reduce the morbidity from surgery are eagerly awaited. ASA classification is a system for assessing the fitness of patients before surgery worldwide adopted. A frailty index predicting adverse outcomes in urologic oncological major surgeries was validated by Lascano (1) and simplified by Chappidi (2) for radical cystectomy. The aim of our prospective study was to compare the modified frailty index (mFI) and the ASA score in consecutive patients undergoing urological procedures for oncological and non-oncological diseases.METHODS: Consecutive patients undergoing urological procedures were prospectively entered. The surgical intervention were classified as follows: 1. Major open/laparoscopic; 2. Lower urinary tract endoscopy; 3. Upper urinary tract procedures; 4 Minor surgery. For all patients age, ASA score, BMI, serum albumin, smoking history and routine hematological exams were preoperatively recorded. mFI was calculated. Operative time, hospital length of stay and post-operative complications according to Clavien-Dindo classification were recorded.RESULTS: 247 consecutive patients, 203 men and 44 women underwent urological surgery. Age was over 75 years in 53 (21%) patients. Patients' characteristics are given in table 1. While 239 (97%) were assigned in ASA 2 and 3 categories, they resulted more widely distributed among the 5 MFI levels.Particularly of the 165 patients classified as ASA 3-4, 37 (22.4%) only were allocated in 3-5 mFI index and on the contrary of the 82 patients in ASA 1-2 classes, 79 (96.3%) were allocated in 0-2 mFI categories.At univariate analysis both ASA and mFI were not associated with any complications (p[0.76 and p[0.67), serious complications (p[0.06 and p[0.49), and late complications rates (p[0.46 and p[0.28). mFI was associated with age (p<0.05) only, while ASA index only with age (p<0.05), readmission rate (p[0.03) and length of hospital stay (p[0.004).CONCLUSIONS: A correspondence between ASA and mFI emerges only for low risk classes, since 22% only of the patients classified as ASA 3-4 resulted allocated in the corresponding high risk classes of mFI. In Both mFI and ASA were not associated with complication incidence when oncological and non oncological urologic surgery is considered.

Is Frailty a Good Predictor of Postoperative Complications in Elective Abdominal Surgery?—A Single-Center, Prospective, Observational Study

“…In a study by Kim et al published in 2014, the multidimensional frailty score based on comprehensive geriatric assessment (CGA) was more useful than ASA PS in predicting outcomes (postoperative mortality and length of hospitalisation) in geriatric patients undergoing surgery (AU ROC 0.821 vs. 0.647; p = 0.01) [ 35 ]. According to another study by Serrett et al, both mFI and ASA were not associated with complication rates for oncologic and nononcologic urologic surgery, although this study used mFI rather than CGA to assess frailty [ 36 ]. In still another study, Yin et al found out that ASA PS classification was associated with the risk of negative outcome (AU ROC = 0.768) in a population of elderly patients undergoing abdominal surgery; of the scales studied, only the CFS significantly improved the predictive value of ASA classification (AU ROC = 0.815; p = 0.048).…”