Frailty and Greater Health Care Resource Utilization Following Major Urologic Oncology Surgery

Background: In the setting of value-based care, it is critical to improve our understanding of surgical risk and greater health care resource utilization (HRU) as it relates to frailty. Objective: To evaluate the impact of frailty on HRU and surgical morbidity in urologic oncology surgery using the five-item frailty index. Design, Setting, and Participants: A retrospective cohort study was conducted using subjects from the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program who underwent radical cystectomy or minimally invasive or open radical prostatectomy, radical nephrectomy, or partial nephrectomy. Outcome measurements and statistical analysis: Multivariable logistic regression was performed to determine the association between frailty index and any increase in HRU, which was defined as prolonged length of stay greater than the 75th percentile, discharge to continued care, or unplanned readmission within 30 d. Result and limitations: In the overall cohort of 92 999 subjects and within each surgery type, increasing frailty score was associated with significant stepwise increases in HRU. Logistic regression adjusting for patient demographics revealed statistically significant odds ratios of 1.2 (95% confidence interval [CI] 1.2-13; p < 0.001), 1.5 (95% CI 1.4-1.6; p < 0.001), and 2.0 (95% CI 1.8-2.1; p < 0.001) at frailty indices of 1, 2, and >3, respectively, for increased HRU relative to no frailty. In subanalyses, each categorical increase in frailty index was independently associated with prolonged length of stay, more discharges to continued care, and unplanned readmission. Increasing frailty score was associated with increasing rates of any complication and serious complications within each surgery type. The analysis is limited by the retrospective design and available data within a large hospital-based database. Conclusions: Frailty in major urologic oncology surgery is associated with greater HRU and surgical morbidity. Patient summary: We assessed the impact of frailty on greater health care resource utilization and complications after major urologic cancer surgery in a large US population. With each increase in a frailty score, there was an increase in the likelihood of having complications, prolonged hospital stay, more discharges to continued care, and unplanned readmissions within 30 d. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.