Nik-Ahd Farnoosh, Zhao Shoujun, Wang Lufan, Boscardin W John, Covinsky Kenneth, Suskind Anne M
Department of Urology, University of California, San Francisco, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
Neurourol Urodyn. 2025 Jan;44(1):143-152. doi: 10.1002/nau.25573. Epub 2024 Oct 7.
Surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are commonly performed in older adults, many of whom are also frail. A surgical risk calculator for older adults undergoing POP/SUI surgeries that incorporates frailty, a factor known to increase the risk of surgical complications, would be helpful for preoperative counseling but currently does not exist.
Medicare Carrier, Outpatient, and MedPAR files were examined for beneficiaries undergoing POP and SUI surgery between 2014 and 2016. A total of 15 POP/SUI categories were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and Charlson Comorbidity Index were deconstructed into their individual variables, and individual variables were entered into stepwise logistic regression models to determine which variables were most highly predictive of 30-day complications and 1-year mortality. To verify the prognostic accuracy for each model for surgical complications of interest, calibration curves and tests of model fit, including C-statistic, Brier scores, and Spiegelhalter p values, were determined.
In total, 108 479 beneficiaries were included. Among these, 4.7% had CFI scores consistent with mild to severe frailty (CFI≥0.25). A total of 13 prognostic variable categories were found to be most highly predictive of postoperative complications. Calibration curves for each outcome of interest showed models were well-fit. Most models demonstrated high c-statistic values (≥0.7) and high Spiegelhalter p values (≥0.9), indicating good model calibration and excellent discrimination, and low Brier scores (<0.02), indicating high model accuracy.
Urologic surgery for older Adults Risk Calculator serves as a novel surgical risk calculator that is readily accessible to both patients and clinicians that specifically factors in components of frailty. Furthermore, this calculator accounts for the heterogeneity of an aging population and can assist in individualized surgical decision-making for these common procedures.
盆腔器官脱垂（POP）和压力性尿失禁（SUI）手术在老年人中较为常见，其中许多人身体也较为虚弱。对于接受POP/SUI手术的老年人而言，纳入虚弱这一已知会增加手术并发症风险的因素的手术风险计算器，将有助于术前咨询，但目前尚不存在。
对医疗保险承保人、门诊病人和医疗住院费用报销文件进行审查，以获取2014年至2016年间接受POP和SUI手术的受益人信息。总共检查了15种POP/SUI类别。基于索赔的虚弱指数（CFI）是医疗保险数据中经过验证的虚弱衡量指标，将其与查尔森合并症指数分解为各自的变量，并将各个变量输入逐步逻辑回归模型，以确定哪些变量对30天并发症和1年死亡率的预测性最高。为验证每个感兴趣的手术并发症模型的预后准确性，确定了校准曲线和模型拟合检验，包括C统计量、Brier评分和斯皮格尔哈特p值。
总共纳入了108479名受益人。其中，4.7%的人CFI评分与轻度至重度虚弱一致（CFI≥0.25）。总共发现13个预后变量类别对术后并发症的预测性最高。每个感兴趣结果的校准曲线显示模型拟合良好。大多数模型显示出较高的C统计量值（≥0.7）和较高的斯皮格尔哈特p值（≥0.9），表明模型校准良好且区分度极佳，以及较低的Brier评分（<0.02），表明模型准确性高。
老年泌尿外科手术风险计算器是一种新颖的手术风险计算器，患者和临床医生均可轻松获取，且专门考虑了虚弱因素。此外，该计算器考虑了老年人群的异质性，可协助对这些常见手术进行个体化手术决策。
