The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures.

OBJECTIVES: To determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure.

METHODS: This is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006-2013. Frailty was quantified using the NSQIP-FI (Frailty Index) and was applied to logistic regression models predicting 30-day complications (overall, major and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure).

RESULTS: We identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% CI 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% CI 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, p<0.01).

CONCLUSIONS: Men undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.