Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
Department of Surgery, Nnamdi Azikiwe University College of Medicine, Awka, Anambra State, Nigeria.
World J Urol. 2023 Sep;41(9):2519-2526. doi: 10.1007/s00345-023-04511-y. Epub 2023 Jul 15.
Frailty is reportedly associated with poorer outcomes among surgical patients. Using a coding-based frailty tool, we investigated the impact of frailty on clinical outcomes and resource utilization for urolithiasis hospitalizations.
A cohort study using the 2018 National Inpatient Sample database. All adult elective hospitalizations for urolithiasis were included in the study. The study population was categorized into FRAIL and non-frail (nFRAIL) cohorts using the Johns Hopkins Adjusted Clinical Groups frailty clusters. The association between frailty and clinical and financial outcomes was evaluated using multivariate regression models.
About 1028 (14.9%) out of 6900 total hospitalizations were frail. Frailty was not associated with a significant increase in the odds of in-hospital mortality (adjusted odds ratio (aOR) 1.73, 95% CI 0.15-20.02) or length of hospital stay, but was associated with a lower chance of surgery within 24 h of admission (aOR 0.65, 95% CI 0.48-0.90, P = 0.008). A higher Charlson index was independently associated with an over 100% increase in the odds of in-hospital mortality (aOR 2.091, 95% CI 1.53-2.86, P < 0.001). Frail patients paid $15,993 higher in total hospital costs and had a higher likelihood of non-home discharges (aOR 4.29, 95% CI 2.74-6.71, P < 0.001) and peri-operative complications (aOR 1.77, 95% CI 1.14-2.73, P = 0.01).
Frailty was correlated with unfavorable outcomes, except mortality and prolonged hospital stay. Incorporating frailty evaluation into risk models has the potential to enhance patient selection and preparation for urolithiasis intervention.
据报道，虚弱与手术患者的预后较差有关。本研究使用基于编码的虚弱工具，研究了虚弱对尿石症住院患者临床结局和资源利用的影响。
这是一项使用 2018 年国家住院患者样本数据库的队列研究。所有接受择期治疗的尿石症住院患者均纳入本研究。使用约翰霍普金斯调整临床组虚弱聚类，将研究人群分为脆弱（FRAIL）和非脆弱（nFRAIL）队列。使用多变量回归模型评估虚弱与临床和财务结局的关系。
在 6900 例总住院患者中，约有 1028 例（14.9%）为虚弱患者。虚弱与院内死亡率（调整后的优势比（aOR）1.73，95%置信区间（CI）0.15-20.02）或住院时间无显著相关性，但与入院 24 小时内手术的机会降低相关（aOR 0.65，95%CI 0.48-0.90，P=0.008）。较高的Charlson 指数与院内死亡率的几率增加超过 100%独立相关（aOR 2.091，95%CI 1.53-2.86，P<0.001）。虚弱患者的总住院费用增加了 15993 美元，非家庭出院的可能性更高（aOR 4.29，95%CI 2.74-6.71，P<0.001）和围手术期并发症（aOR 1.77，95%CI 1.14-2.73，P=0.01）。
虚弱与不良结局相关，除了死亡率和延长的住院时间。将虚弱评估纳入风险模型有可能增强患者选择和准备接受尿石症干预。
