Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan.
Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
World J Urol. 2024 May 15;42(1):323. doi: 10.1007/s00345-024-05016-y.
This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones.
Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups.
Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups.
The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.
本研究旨在评估改良的 5 项衰弱指数对上尿路结石患者行输尿管镜激光碎石术围手术期并发症和手术结局的影响。
回顾性分析 2019 年至 2022 年间接受输尿管镜激光碎石术治疗上尿路结石的患者。采用基于病史（高血压、糖尿病、心力衰竭、慢性阻塞性肺疾病）和功能状态的改良的 5 项衰弱指数进行评估。根据衰弱评分，将患者分为高（≥2）和低（≤1）改良 5 项衰弱指数组。比较两组围手术期并发症和手术结局。
467 例患者中，71 例（15.8%）和 393 例（84.1%）分别归入高和低改良 5 项衰弱指数组。与低改良 5 项衰弱指数组相比，高改良 5 项衰弱指数组发热性尿路感染的发生率显著增加[≥37.8°C：15 例（20.3%）比 13 例（3.3%），p<0.001；≥38°C：9 例（12.2%）比 7 例（1.8%），p<0.001]。两组的手术结局，包括手术时间和结石清除率，无显著差异。
改良的 5 项衰弱指数可预测上尿路结石患者行输尿管镜激光碎石术后的术后并发症，尤其是发热性尿路感染。该指数可用于对接受输尿管镜激光碎石术的患者进行实用的术前风险评估。
