Chaker Kays, Ouanes Yassine, Marrak Mahdi, Gharbia Nader, Rahoui Moez, Mosbahi Boutheina, Bibi Mokhtar, Chedly Wassim Ben, Nouira Yassine
Urology Department, LA RABTA Hospital, University of Tunis El Manar, Bab Saadoun, 1006, Tunis, Tunisia.
Anesthesiology Department, LA RABTA Hospital, University of Tunis El Manar, Tunis, Tunisia.
Int Urol Nephrol. 2025 Jan;57(1):93-97. doi: 10.1007/s11255-024-04178-3. Epub 2024 Aug 1.
The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL.
A database of patients undergoing PCNL, between 2015 and 2022, was analyzed. Patient frailty was assessed using the mFI-5 index. The mFI-5 index was calculated based on the presence of the five co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 ≥ 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospitalization: total hospital length of stay, reoperation, and unplanned readmission.
From a total of 320 PCNL patients included for analysis, 54.06% (n = 173) were not frail, 17.81% (n = 57) were intermediate, and 28.12% (n = 90) were severely frail. Frail patients were likely to be older (p = 0.002) and have a higher American Society of Anesthesiologists score (p = 0.001), chronic kidney disease (p < 0.001). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p = 0.042), significant blood loss (p = 0.036) and require intensive care units admissions (p = 0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require reoperation (p = 0.001), and unplanned readmission (p = 0.02).
Frailty assessment appears useful in stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.
改良的5项衰弱指数是一种相对较新的评估术后并发症风险的工具。在泌尿外科领域，关于衰弱对经皮肾镜取石术（PCNL）结局影响的文献有限。我们旨在比较改良的5项衰弱指数（mFI-5）在PCNL术前识别高危患者的预测价值。
分析了2015年至2022年间接受PCNL患者的数据库。使用mFI-5指数评估患者的衰弱情况。mFI-5指数基于以下五种合并症的存在情况计算：手术前30天内的充血性心力衰竭、糖尿病、慢性阻塞性肺疾病、手术时部分依赖或完全依赖的功能健康状况，以及需要药物治疗的高血压。患者分为非衰弱组（mFI-5 = 0）、中度衰弱组（mFI-5 = 1）和重度衰弱组（mFI-5≥2）。主要结局是术后30天并发症。次要结局包括住院情况：总住院时长、再次手术和非计划再入院。
在纳入分析的320例PCNL患者中，54.06%（n = 173）为非衰弱患者，17.81%（n = 57）为中度衰弱患者，28.12%（n = 90）为重度衰弱患者。衰弱患者年龄可能更大（p = 0.002），美国麻醉医师协会评分更高（p = 0.001），慢性肾脏病患病率更高（p < 0.001）。中度或重度衰弱患者更易出现术后脓毒症（p = 0.042）、大量失血（p = 0.036），且需要入住重症监护病房（p = 0.0015）。衰弱患者住院时间更长（p < 0.001），且倾向于需要再次手术（p = 0.001）和非计划再入院（p = 0.02）。
衰弱评估似乎有助于对PCNL术后有延长住院、脓毒症和出血并发症、再入院或再次手术风险的患者进行分层。术前对衰弱表型的评估可能有助于治疗决策，并协助外科医生向患者咨询PCNL后的预期病程和住院时间。
