• Anne M Suskind, Chengshi Jin, Matthew R Cooperberg, Emily Finlayson, W John Boscardin, Saunak Sen, and Louise C Walter.
• Department of Urology, University of California, San Francisco, CA. Electronic address: Anne.Suskind@ucsf.edu.
• Urology. 2016 Nov 1; 97: 25-32.

ObjectiveTo evaluate the association between frailty and postoperative discharge destination after different types of commonly performed urologic procedures in older patients.Materials And MethodsUsing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2011 to 2013, we identified commonly performed inpatient urologic procedures among patients aged 65 and older. We then assessed the effect of frailty, measured by the NSQIP Frailty Index (NSQIP-FI), on discharge to a skilled or assisted living facility using logistic regression and assessed the heterogeneity of this effect across procedures using 2-level random effects modeling.ResultsOverall, 1144 out of 20,794 (5.5%) urologic cases, representing 19 different procedures, resulted in discharge to a skilled or assisted living facility. Cystectomy and large transurethral resection of bladder tumor had the highest percentage (16.3%). Twenty-five percent of patients undergoing urology procedures were frail (NSQIP-FI 0.18+), including 9.8% of patients discharged to a facility. Even after adjustment for year, age, race, type of anesthesia, smoking status, recent weight loss, and whether or not the procedure was elective, frailty was strongly associated with discharge to a facility (adjusted odds ratio 3.1 [96% confidence interval 2.5, 3.8] for NSQIP-FI 0.18+ compared to NSQIP FI 0). This finding was consistent across most procedures of varying complexity with an overall effect of odds ratio 1.6 (95% confidence interval 1.5, 2.0).ConclusionIncreasing frailty is associated with discharge to a skilled or assisted living facility across most inpatient urologic procedures evaluated, regardless of complexity. This information is important for preoperative counseling with patients undergoing urologic surgery.Copyright © 2016 Elsevier Inc. All rights reserved.

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