I'm Karen Inovaggio, and we are moderating session, concurrent session, surgical. We are going to go out of order because Dr. Ongur was inadvertently also listed to moderate the session next door, so I will use moderator privileges to let Dr. Ongur, the second presentation, go first. Dr. Ongur, with her questions to follow, will you introduce? Yes, the title of her presentation is The Effect of Frailty on Outcomes of Spleen Surgery for Urinary Incontinence. Thank you so much, and I appreciate the special accommodation. Frailty is a concept with a variable definition, which has a phenotypic model as well as accumulated deficits model. Frailty is considered a syndrome by some and a series of age-related impairments by others. Comorbidity is often a cause of frailty, which ultimately leads to disability. Frailty is defined as a decrease in physiological capacity that predisposes to poor outcomes in the face of stressors such as surgery. Frailty can include multiple domains, malnutrition, homebound, weakness, weight loss, dementia, and polypharmacy, to name a few. We studied the effect of age on outcomes of sling surgery, and this was Medicare public use files, and showed that age over 65 was a predictor of urgent incontinence after surgery, treatment failure, outlet obstruction, and non-neurologic or systemic complications such as MI and DVT, etc. Ann Suskin showed that frailty actually had an impact on surgical outcomes and was even more important than age, and this was for 21 common urologic procedures, and she performed a similar study in the case of scopal clysis and also showed that frailty was an independent risk factor separate from age. NISQIP is the National Surgery Quality Improvement Program, which is a nationalized sample of over a million cases from 680 sites. Over 150 variables can be studied. Data extends to 30 days, so this is something that measures acute perioperative complications. A frailty index was developed by Vilanovich, which used 11 factors and showed that there was a stepwise increase in morbidity and mortality for each unit increase in the frailty index. And this, the 11 points included diabetes, functional status, hypertension, stroke, and MI, etc. Since then, a five-factor frailty index has been used, and this was developed by Subramanian, whereas it's focused on diabetes, functional status, a history of severe COPD, CHF, and hypertension. They show that the five-point index is as effective as the 11-point in measuring frailty. We used NISQIP data from 2013 to 2016, identifying patients by a CPT code for sling and stratified them by the presence or absence of a prolapse repair, applied the Fi5, and identified that two out of five frailty factors constituted a component of frailty. We then conducted logistic regression models to adjust for age, BMI, and frailty. These were many of the post-op variables that we applied, but our focus was on these. Operation time, length of stay, UTI, unplanned reoperation, and hospital readmission. We had over 25,000 cases, 15,000 in sling only and 10,000 in sling plus prolapse repair. Here are the demographics, and of note, the older group was more likely to be white and non-Hispanic and had actual lower BMIs in terms of the percentage of normals, but also actually had lower obesity than group one. Overall, those that had any frailty variables constituted 40% of the population, and if you look below where they're stratified by groups one and two, the group two, so sling plus prolapse, had a slightly more frailty at 43% versus 37%. Here you see that less than 10% had two of five factors, and less than a half of 1% had three or more factors, and this is actually good because this means we're not doing a lot of slings on frail people, which is a good thing. And then you can see that the small number of more frail people, which was three out of five on the bottom of this slide, were 0.5% for the total, and in looking at 2016 alone, it was 0.4%. Here you can see that frailty had a significant impact on length of stay and any hospital readmission, whereas age greater than 65 had a significant adverse impact on operation time as well as length of stay. Interestingly, normal and underweight had a higher likelihood of unplanned reoperation. Sling plus prolapse showed that frailty had an impact on hospital readmission as well, and age had an impact on unplanned reoperation. BMI, lower body weight, higher risk of unplanned reoperation, and that was in both the sling and prolapse group. In conclusion, there was a low prevalence of frailty amongst sling patients, which is a good thing. Increased age and frailty were both associated with increased length of hospital stay. Frailty but not age increased the likelihood of readmission after sling with or without prolapse repair. Thank you. Thank you very much.

frailty

spleen surgery

urinary incontinence

surgical outcomes

age and frailty