Comparing mFI-5,ASA Class,and mCCI as Predictors of Postoperative Outcomes Following Endoscopic Treatment of BPH

Abstract

While many risk indexes for predicting morbidity following urological surgery have been reported, determining the best ones for clinical use is challenging. A new frailty index (mFI-5) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH), but its effectiveness for predicting postoperative complications has not been investigated. We compared mFI-5 with the two most commonly used indexes, the American Society of Anesthesiologists (ASA) physical classification and the modified Charlson Comorbidity Index (mCCI), and the total number of comorbidities using the National Surgical Quality Improvement Program (NSQIP) database. We retrospectively queried the 2015–2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using Current Procedural Terminology and International Classification of Diseases codes. Patients were stratified by procedure type (transurethral resection of prostate [TURP], laser vaporization of prostate [LVP], laser enucleation of prostate [LEP]). Risk indexes were calculated and compared as predictors of postoperative using logistic regression and C-statistics. 38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%. When stratifying based on surgery type, the complication rates were 11.0% for TURP, 10.3% for LVP, and 7.6% for LEP. Discriminatory ability of risk indexes was mostly comparable between risk indexes but differed based on procedure type and postoperative outcome. mCCI was found to be superior in predicting surgical complications for TURP and in predicting unplanned reoperation and increased length of stay for LVP. ASA Class was found to be superior in predicting all-cause complication, unplanned reoperation, and complication for LEP. mFI-5 was not superior to any index in predicting any postoperative outcome. mCCI and ASA Class have utility in predicting postoperative outcomes for LVP and LEP, respectively. Most risk indexes are comparable and therefore can be utilized at the ease of the provider.

Keywords

frailty index NSQIP prostate TURP

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References

Egan

. The epidemiology of benign prostatic hyperplasia associated with lower urinary tract symptoms: Prevalence and incident rates. Urol Clin North Am, 2016; 43(3):289–297; doi: 10.1016/j.ucl.2016.04.001

Franco

, Jung

, Imamura

, et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: A network meta-analysis. Cochrane Database Syst Rev, 2021; 7(7):Cd013656; doi: 10.1002/14651858.cd013656.pub2

Guo

, Yu

, Meng

, et al. Correlation of ASA grade and the charlson comorbidity index with complications in patients after transurethral resection of prostate. Urology, 2016; 98:120–125; doi: 10.1016/j.urology.2016.07.025

Jeldres

, Isbarn

, Capitanio

, et al. Development and external validation of a highly accurate nomogram for the prediction of perioperative mortality after transurethral resection of the prostate for benign prostatic hyperplasia. J Urol, 2009; 182(2):626–632; doi: 10.1016/j.juro.2009.04.008

Shahait

, Labban

, Dobbs

, et al. A 5-Item frailty index for predicting morbidity and mortality after radical prostatectomy: An analysis of the american college of surgeons national surgical quality improvement program database. J Endourol, 2021; 35(4):483–489; doi: 10.1089/end.2020.0597

Goldwag

, Harris

, Bettis

. 5-Item modified frailty index as a preoperative predictor of morbidity following minimally invasive partial nephrectomy. Urology, 2021; 157:138–142; doi: 10.1016/j.urology.2021.05.050

Yamashita

, Mashima

, Higuchi

, et al. Modified 5-Item frailty index score as prognostic marker after radical cystectomy in bladder cancer. Clin Genitourin Cancer, 2022; 20(3):e210–e216; doi: 10.1016/j.clgc.2021.12.016

Subramaniam

, Aalberg

, Soriano

, Divino

. New 5-Factor modified frailty index using American college of surgeons NSQIP data. J Am Coll Surg, 2018; 226(2):173–181; doi: 10.1016/j.jamcollsurg.2017.11.005

Labban

, Frego

, Qian

, et al. Does the 5-item Frailty Index predict surgical complications of endoscopic surgical management for benign prostatic obstruction? An analysis of the ACS-NSQIP. World J Urol, 2022; 40(11):2649–2656; doi: 10.1007/s00345-022-04151-8

10.

Hong

J-Y

, Yang

, Ahn

, Kil

. Preoperative comorbidities and relationship of comorbidities with postoperative complications in patients undergoing transurethral prostate resection. J Urol, 2011; 185(4):1374–1378; doi: 10.1016/j.juro.2010.11.086

11.

Mandal

, Sankhwar

, Kathpalia

, et al. Grading complications after transurethral resection of prostate using modified Clavien classification system and predicting complications using the Charlson comorbidity index. Int Urol Nephrol, 2013; 45(2):347–354; doi: 10.1007/s11255-013-0399-x

12.

Shamout

, Carlson

, Brotherhood

, Crump

, Baverstock

. Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: A population-based cohort study. BJU Int, 2021; 127(2):238–246; doi: 10.1111/bju.15191

13.

Cullen

, Apolone

, Greenfield

, Guadagnoli

, Cleary

. ASA physical status and age predict morbidity after three surgical procedures. Ann Surg, 1994; 220(1):3–9; doi: 10.1097/00000658-199407000-00002

14.

Kore

, Blacklock

. American Society of Anaesthesiologist Physical Status (ASA-PS): A predictor of treatment outcome of Transurethral Resection of the Prostate (TURP). J R Coll Surg Edinb, 2000; 45(1):25–28.

15.

Valerio

, Cerantola

, Fritschi

, et al. Comorbidity and nutritional indices as predictors of morbidity after transurethral procedures: A prospective cohort study. Can Urol Assoc J, 2014; 8(9–10):E600–E604; doi: 10.5489/cuaj.2490

16.

Nguyen

D-D

, Deyirmendjian

, Law

, et al. GreenLight photovaporization of the prostate in high-medical-risk patients: An analysis of the Global Green Light Group (GGG) database. World J Urol, 2022; 40(7):1755–1762; doi: 10.1007/s00345-022-03986-5

17.

Soyster

, Agarwal

, Slade

, Sahm

, Large

, Rivera

. Impact of American society of anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications. Prostate, 2023; 83(4):316–322; doi: 10.1002/pros.24463

18.

Riveros

, Di Valerio

, Bacchus

, et al. Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate. Prostate Int, 2023; 11(1):20–26; doi: 10.1016/j.prnil.2022.07.003

19.

Meng

, Press

, Renson

, et al. Discriminative ability of commonly used indexes to predict adverse outcomes after radical cystectomy: Comparison of demographic data, American society of anesthesiologists, modified charlson comorbidity index, and modified frailty index. Clin Genitourin Cancer, 2018; 16(4):e843–e850; doi: 10.1016/j.clgc.2018.02.009

20.

Woldu

, Sanli

, Clinton

, Lotan

. Validating the predictors of outcomes after radical cystectomy for bladder cancer. Cancer, 2019; 125(2):223–231; doi: 10.1002/cncr.31799

21.

Haeuser

, Herzog

, Ayub

, et al. Comparison of comorbidity indices for prediction of morbidity and mortality after major surgical procedures. Am J Surg, 2021; 222(5):998–1004; doi: 10.1016/j.amjsurg.2021.04.007