Hinojosa-Gonzalez David E, Saffati Gal, Salgado-Garza Gustavo, Armengol Garcia Cecilio, Chaput Madeline, Yu Benjamin, Miranda-Abghary Lauren, Blackwell Sienna, Slawin Jeremy R, Mayer Wesley A
Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St, Houston, TX, USA.
Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
J Robot Surg. 2025 Apr 11;19(1):147. doi: 10.1007/s11701-025-02305-5.
Frailty and malnutrition are recognized risk factors for poor surgical outcomes, yet their specific impact on perioperative outcomes in patients undergoing minimally invasive radical nephrectomy (RN) remains underexplored. This study aims to evaluate how frailty, as measured by the Modified 5-Item Frailty Index (mFI-5), and nutritional status, via the Nutritional Risk Index (NRI), affects short-term outcomes in patients undergoing minimally invasive RN. A retrospective analysis was conducted using the ACS-NSQIP database (2019-2022), identifying 7324 patients who underwent minimally invasive RN. Frailty was defined by an mFI-5 score ≥ 2, and malnutrition was identified with an NRI ≤ 97.5. Outcome measures included hospital length of stay, operative time, major complications, and mortality. Statistical analysis involved logistic regression to assess associations, with odds ratios (OR) and 95% confidence intervals (CI). Of 7324 patients, 24.5% were frail and 6.5% malnourished. Frail patients had significantly longer hospital stays (3.34 vs. 2.57 days, p < 0.001), extended operative times (178 vs. 165 min, p < 0.001), and higher rates of major complications (16.4% vs. 10.3%, p < 0.001) compared to non-frail patients. Malnourished patients also experienced higher major complication rates (30.7% vs. 11.6%, p < 0.001) and 30-day mortality (2.47% vs. 0.60%, p = 0.003). Preoperative albumin levels were the most predictive for mortality (AUC 0.72) and transfusion needs (AUC 0.72). Frailty and malnutrition significantly increase perioperative risks in patients undergoing minimally invasive RN. Preoperative assessments focusing on frailty and nutritional status may improve patient counseling, risk stratification, and help target preoperative interventions that may lead to improved perioperative outcomes.
衰弱和营养不良是公认的手术预后不良的风险因素，然而它们对接受微创根治性肾切除术（RN）患者围手术期结局的具体影响仍未得到充分研究。本研究旨在评估通过改良的5项衰弱指数（mFI-5）衡量的衰弱以及通过营养风险指数（NRI）评估的营养状况如何影响接受微创RN患者的短期结局。使用ACS-NSQIP数据库（2019 - 2022年）进行回顾性分析，确定7324例接受微创RN的患者。衰弱定义为mFI-5评分≥2，营养不良定义为NRI≤97.5。结局指标包括住院时间、手术时间、主要并发症和死亡率。统计分析采用逻辑回归评估相关性，给出比值比（OR）和95%置信区间（CI）。在7324例患者中，24.5%为衰弱患者，6.5%为营养不良患者。与非衰弱患者相比，衰弱患者的住院时间显著更长（3.34天对2.57天，p < 0.001），手术时间延长（178分钟对165分钟，p < 0.001），主要并发症发生率更高（16.4%对10.3%，p < 0.001）。营养不良患者的主要并发症发生率也更高（30.7%对11.6%，p < 0.001）以及30天死亡率更高（2.47%对0.60%，p = 0.003）。术前白蛋白水平对死亡率（AUC 0.72）和输血需求（AUC 0.72）的预测性最强。衰弱和营养不良显著增加接受微创RN患者的围手术期风险。关注衰弱和营养状况的术前评估可能改善患者咨询、风险分层，并有助于确定可能改善围手术期结局的术前干预措施。
