Login to Access Video or Poster Abstract: MP72-11
Sources of Funding: None

Introduction

To evaluate the condensed 5-item frailty index (FFI) based on contemporary National Surgical Quality Improvement Program (NSQIP) database as a predictor of increased healthcare resource utilization (HRU) after elective minimally invasive radical nephrectomy (MIRN).

Methods

The NSQIP database (2012 - 2015) was used to identify patients with renal cell carcinoma who had elective MIRN. The primary outcome of interest was increased HRU, which was pre-defined as prolonged length of hospital stay (PLOS) (> 4 d), discharged to continued care (DCC), and unplanned readmission (UR) within 30 days of surgery. FFI was modified from the previously reported 11-item frailty index and based on 6 variables were not collected in recent NSQIP database possibly because of infrequent occurrence. FFI was calculated by scoring following items (full score of 6): diabetes (1 if on oral agents, 2 if on insulin), impaired functional status (1), chronic obstructive pulmonary disease (1), hypertension requiring medication (1), and congestive heart failure in 30 days before surgery (1). Patients were stratified into 4 groups by FFI (0, 1, 2, and ≥ 3) and outcomes were compared. Multivariable logistic regression was performed to determine whether FFI could independently predict increased HRU outcomes.

Results

A total of 2,321 patients were included. Increased HRU outcomes stratified by FFI were shown in Figure 1 and there was increasing likelihood with increasing FFI. Multivariable logistic regression showed that FFI = 2 (OR = 1.96 [1.36-2.81], P <0.001) and FFI ≥ 3 (OR = 3.10 [2.08-4.62], P <0.001) were independent predictors of overall increased HRU. When the outcomes of PLOS, DCC, and UR were analyzed separately, FFI = 2 (OR = 1.78, P = 0.006 for PLOS, OR = 4.61, P = 0.008 for DCC, and OR = 1.93, P = 0.042 for UR) and FFI≥ 3 (OR = 2.73, P < 0.001 for PLOS, OR = 7.85, P < 0.001 for DCC, and OR = 2.47, P = 0.009 for UR) were still independently associated with each individual outcome.

Conclusions

The readily available and easily reproducible FFI correlates with increased HRU after MIRN. FFI might be a useful tool to patients, providers, and healthcare policy makers in terms of surgical safety as well as cost outcomes. Further studies are needed to validate our findings.

Funding

None