Nik-Ahd Farnoosh, Zhao Shoujun, Wang Lufan, John Boscardin W, Covinsky Kenneth, Suskind Anne M
Department of Urology, University of California, San Francisco, San Francisco, CA.
Department of Urology, University of California, San Francisco, San Francisco, CA.
Urology. 2025 Mar;197:2-9. doi: 10.1016/j.urology.2024.10.007. Epub 2024 Oct 12.
To develop a surgical risk calculator for older adults undergoing suprapubic tube (SPT) placement that specifically factors in frailty, a key predictor of surgical risk in this vulnerable and heterogenous population.
Medicare MedPAR, Outpatient, and Carrier files for beneficiaries undergoing SPT placement between 2014-2016 were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty, was used to calculate baseline frailty for each beneficiary. Stepwise regression models were used for each variable within the CFI and Charlson Comorbidity Index to determine the variables most highly predictive of postoperative complications. The most highly predictive variables were then combined into parsimonious categories. To ensure the prognostic accuracy for each outcome, calibration curves and tests of model fit, including C-statistics, Brier scores, and Spiegelhalter P-values were calculated.
A total of 26,999 beneficiaries were included. Among these, 39.1% were pre-frail, 36.8% were mildly frail, and 12.3% were moderately to severely frail. Thirteen prognostic variable categories were deemed highly predictive of postoperative complications of interest. All models demonstrated low Brier scores, indicating high model accuracy, and high C-statistic and Spiegelhalter P-values, consistent with excellent model discrimination and calibration, respectively. Excellent model fit was seen on calibration curves for each outcome.
UroARC is a novel surgical tool for older adults undergoing SPT placement that specifically factors in frailty. This risk calculator has high accuracy, calibration, and discrimination, and serves as a valuable resource to patients and clinicians for those undergoing consideration for SPT placement.
开发一种用于接受耻骨上造瘘管（SPT）置入术的老年人的手术风险计算器，该计算器专门考虑了虚弱这一因素，而虚弱是这个脆弱且异质性人群手术风险的关键预测指标。
研究了2014 - 2016年间接受SPT置入术的受益人的医疗保险MedPAR、门诊和承运人档案。基于索赔的虚弱指数（CFI）是一种经过验证的虚弱测量方法，用于计算每个受益人的基线虚弱程度。对CFI和Charlson合并症指数中的每个变量使用逐步回归模型，以确定对术后并发症预测性最高的变量。然后将预测性最高的变量合并为简洁的类别。为确保每个结局的预后准确性，计算了校准曲线和模型拟合检验，包括C统计量、Brier评分和Spiegelhalter P值。
共纳入26,999名受益人。其中，39.1%为虚弱前期，36.8%为轻度虚弱，12.3%为中度至重度虚弱。13个预后变量类别被认为对感兴趣的术后并发症具有高度预测性。所有模型的Brier评分都很低，表明模型准确性高，C统计量和Spiegelhalter P值都很高，分别与出色的模型区分度和校准度一致。每个结局的校准曲线上都显示出出色的模型拟合。
UroARC是一种用于接受SPT置入术的老年人的新型手术工具，该工具专门考虑了虚弱因素。这种风险计算器具有很高的准确性、校准度和区分度，对于正在考虑进行SPT置入术的患者和临床医生而言是一种宝贵的资源。
