Frailty Is Associated With Postoperative Complications and Device Removal and Revision in Men Undergoing Surgery for Stress Urinary Incontinence.

PURPOSE: Our goal was to understand the association between frailty and postoperative complications after artificial urinary sphincter (AUS) and male urethral sling placement.

MATERIALS AND

METHODS

This was a retrospective study of Medicare beneficiaries undergoing AUS or sling from 2014 to 2016. Baseline frailty was quantified using the Claims-Based Frailty Index (CFI): not frail (<0.15), prefrail (0.15-0.24), and mildly-to-severely frail (≥0.25). Thirty-day complications and device revision/removal were analyzed using generalized linear regression models with log link, Poisson distribution, and robust standard errors.

RESULTS

Altogether, 7252 men underwent surgery: 62.2% AUS and 37.8% sling. Mean age was 74.2 years (SD 5.6 years), and mean CFI was 0.15 (SD 0.05). Thirty-day complications occurred in 15% (N = 1052), and device revision/removal within 1 year occurred in 11% (N = 841). Thirty-day complications were associated with increasing CFI (prefrail adjusted relative risk [aRR] 1.5, mildly-to-severely frail aRR 2.5, compared with not frail, global P = .0001), age (75-84 aRR 1.2, ≥85 aRR 1.4, compared with 66-74, global P = .0007), and Charlson Comorbidity Index (1-3 aRR 1.2, ≥4 aRR 1.8, compared with 0, global P = .0001). Device revision/removal was associated with increasing CFI (prefrail aRR 1.2, mildly-to-severely frail aRR 1.3, compared with not frail global P = .04) and age (75-84 aRR 1.3, ≥85 aRR 1.5, compared with 66-74, global P = .0002), but not Charlson Comorbidity Index (global P = .2).

CONCLUSIONS

Frailty, independent of age and comorbidity, was associated with increased odds of 30-day complications and device revision/removal. Thus, frailty, more than comorbidity, is an important yet often unrecognized factor that should be considered during preoperative decision-making for AUS or sling procedures.