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

Abstract

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.

Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter

“…Good selection of one or the other device may improve the results of both. Criteria to define the best patient profile can be based on the incontinence magnitude, former irradiation, patient frailty, age, autonomy and manual dexterity [ 18 , 19 ]. Physicians offering different treatment options tend to consider AUS in the more complex patient [ 20 ].…”

Frailty Is Associated with an Increased Risk of Complications and Need for Repeat Procedures after Sling Surgery in Older Adults

“…Our findings underscore the importance of considering and measuring frailty in the preoperative setting, as an emerging body of evidence demonstrates the negative association that frailty has on the risk of postoperative complications. 7–10…”

“…6 There is a growing body of literature indicating that frailty is associated with an increased risk of complications after many types of surgery, including urological procedures. 7–10 Given the paucity of data on outcomes of sling surgery in frail women, it remains unknown whether it is reasonable to perform this type of surgery in this particularly vulnerable population or if it should be avoided entirely.…”

Use of isotonic contrast solution in the artificial urinary sphincter does not impact device longevity

“…This could be why there is an association between device survival and older age when it is well-known that higher age confers more risk. 16 We are also limited by the data collected on the AUS Patient Information Form (Appendix 1). Boston Scientific database does not specifically report the use of contrast, rather, if NS is not used to fill the PRB, the only other option for classification is "other."…”

“…Furthermore, the database only accounts for each surgery and no patient is followed to their death or device deactivation. This could be why there is an association between device survival and older age when it is well‐known that higher age confers more risk 16 …”