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      Impact of frailty on perioperative outcomes following percutaneous nephrolithotomy in older persons: evidence from the US Nationwide Inpatient Sample

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          Abstract

          To evaluate the impact of frailty on perioperative outcomes of older patients undergoing PCNL, utilizing the US Nationwide Inpatient Sample (NIS) database. Data of hospitalized patients ≥ 60 years who received PCNL were extracted from the 2010 to 2020 NIS database, and included demographics, clinical, and hospital-related information. Patients were assigned to low (< 5), medium (5–15), and high frailty risk (> 15) groups based on the hospital frailty risk score (HFRS). Associations between frailty risk and perioperative outcomes including total hospital cost were determined using population-weighted linear and logistic regression analyses. Data of 30,829 hospitalized patients were analyzed (mean age 72.5 years; 55% male; 78% white). Multivariable analyses revealed that compared to low frailty risk, increased frailty risk was significantly associated with elevated in-hospital mortality (adjusted odds ratio (aOR) = 10.70, 95% confidence interval (CI): 6.38–18.62), higher incidence of unfavorable discharge (aOR = 5.09, 95% CI: 4.43–5.86), prolonged hospital length of stay (LOS; aOR = 7.67, 95% CI: 6.38–9.22), increased transfusion risk (aOR = 8.05, 95% CI: 6.55–9.90), increased total hospital costs (adjusted Beta = 37.61, 95% CI: 36.39–38.83), and greater risk of complications (aOR = 8.52, 95% CI: 7.69–9.45). Frailty is a significant prognostic indicator of adverse perioperative outcomes in older patients undergoing PCNL, underscoring importance of recognizing and managing frailty in older patients.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00240-024-01595-y.

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          Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study

          Thomas I. Gilbert, Jenny Neuburger, Joshua Kraindler … (2018)
          Summary Background Older people are increasing users of health care globally. We aimed to establish whether older people with characteristics of frailty and who are at risk of adverse health-care outcomes could be identified using routinely collected data. Methods A three-step approach was used to develop and validate a Hospital Frailty Risk Score from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. First, we carried out a cluster analysis to identify a group of older people (≥75 years) admitted to hospital who had high resource use and diagnoses associated with frailty. Second, we created a Hospital Frailty Risk Score based on ICD-10 codes that characterised this group. Third, in separate cohorts, we tested how well the score predicted adverse outcomes and whether it identified similar groups as other frailty tools. Findings In the development cohort (n=22 139), older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use (33·6 bed-days over 2 years compared with 23·0 bed-days for the group with the next highest number of bed-days). In the national validation cohort (n=1 013 590), compared with the 429 762 (42·4%) patients with the lowest risk scores, the 202 718 (20·0%) patients with the highest Hospital Frailty Risk Scores had increased odds of 30-day mortality (odds ratio 1·71, 95% CI 1·68–1·75), long hospital stay (6·03, 5·92–6·10), and 30-day readmission (1·48, 1·46–1·50). The c statistics (ie, model discrimination) between individuals for these three outcomes were 0·60, 0·68, and 0·56, respectively. The Hospital Frailty Risk Score showed fair overlap with dichotomised Fried and Rockwood scales (kappa scores 0·22, 95% CI 0·15–0·30 and 0·30, 0·22–0·38, respectively) and moderate agreement with the Rockwood Frailty Index (Pearson's correlation coefficient 0·41, 95% CI 0·38–0·47). Interpretation The Hospital Frailty Risk Score provides hospitals and health systems with a low-cost, systematic way to screen for frailty and identify a group of patients who are at greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful. Funding National Institute for Health Research.
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            Outcomes of patients with end-stage kidney disease hospitalized with COVID-19

            Jia H. Ng, Jamie Hirsch, Rimda Wanchoo … (2020)
            Given the high risk of infection-related mortality, patients with end-stage kidney disease (ESKD) may be at increased risk with COVID-19. To assess this, we compared outcomes of patients with and without ESKD, hospitalized with COVID-19. This was a retrospective study of patients admitted with COVID-19 from 13 New York. hospitals from March 1, 2020, to April 27, 2020, and followed through May 27, 2020. We measured primary outcome (in-hospital death), and secondary outcomes (mechanical ventilation and length of stay), Of 10,482 patients with COVID-19, 419 had ESKD. Patients with ESKD were older, had a greater percentage self-identified as Black, and more comorbid conditions. Patients with ESKD had a higher rate of in-hospital death than those without (31.7% vs 25.4%, odds ratio 1.38, 95% confidence interval 1.12 - 1.70). This increase rate remained after adjusting for demographic and comorbid conditions (adjusted odds ratio 1.37, 1.09 - 1.73). The odds of length of stay of seven or more days was higher in the group with compared to the group without ESKD in both the crude and adjusted analysis (1.62, 1.27 - 2.06; vs 1.57, 1.22 - 2.02, respectively). There was no difference in the odds of mechanical ventilation between the groups. Independent risk factors for in-hospital death for patients with ESKD were increased age, being on a ventilator, lymphopenia, blood urea nitrogen and serum ferritin. Black race was associated with a lower risk of death. Thus, among patients hospitalized with COVID-19, those with ESKD had a higher rate of in-hospital death compared to those without ESKD.
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              Kidney stones associate with increased risk for myocardial infarction.

              Amy Krambeck, Patricia Peyser, Xujian Li … (2010)
              Kidney stones are a risk factor for chronic kidney disease (CKD), which, in turn, is a risk factor for myocardial infarction (MI). The objective of this study was to determine whether kidney stones associate with an increased risk for MI. We matched 4564 stone formers (1984 through 2003) on age and gender with 10,860 control subjects among residents in Olmsted County, Minnesota. We identified incident MI by diagnostic codes and validated events by chart review through 2006. We used diagnostic codes to determine incidence of kidney stones and presence of comorbidities (CKD, hypertension, diabetes, obesity, dyslipidemia, gout, alcohol dependence, and tobacco use). During a mean of 9 years of follow-up, stone formers had a 38% (95% confidence interval 7 to 77%) increased risk for MI, which remained at 31% (95% confidence interval 2% to 69%) after adjustment for CKD and other comorbidities. In conclusion, kidney stone formers are at increased risk for MI, and this risk is independent of CKD and other risk factors.
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                Author and article information

                Contributors
                Yaw-Jen Chang: justin@cycu.edu.tw
                Journal
                Journal ID (nlm-ta): Urolithiasis
                Journal ID (iso-abbrev): Urolithiasis
                Title: Urolithiasis
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 2194-7228
                ISSN (Electronic): 2194-7236
                Publication date (Electronic): 19 June 2024
                Publication date PMC-release: 19 June 2024
                Publication date (Print): 2024
                Volume: 52
                Issue: 1
                Electronic Location Identifier: 95
                Affiliations
                [1 ]Department of Mechanical Engineering, Chung Yuan Christian University, ( https://ror.org/02w8ws377) Chung Li District, No. 200, Zhongbei Rd., Zhongli Dist, Taoyuan, 320314 Taiwan (R.O.C.)
                [2 ]Tai-An Hospital, Taichung, 401007 Taiwan
                [3 ]Department of Surgery, Division of Urology, Changhua Christian Hospital, ( https://ror.org/05d9dtr71) 135, Nanxiao St, Changhua, Changhua 500209 Taiwan
                Article
                Publisher ID: 1595
                DOI: 10.1007/s00240-024-01595-y
                PMC ID: 11186895
                PubMed ID: 38896137
                SO-VID: 4e4d7688-f8be-4a4b-8dbe-920b0f1f59fc
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 22 May 2024
                Date accepted : 8 June 2024
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2024

                Keywords: frailty,kidney stones,percutaneous nephrolithotomy (pcnl),perioperative outcomes,hospital frailty risk score (hfrs),nationwide inpatient sample (nis)
                Data availability:
                Keywords: frailty, kidney stones, percutaneous nephrolithotomy (pcnl), perioperative outcomes, hospital frailty risk score (hfrs), nationwide inpatient sample (nis)

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