Development and validation of a multivariable risk score for postoperative complications in urological surgery in older patients: FRAC cohort study.

Background

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Purpose

Multiple frailty assessment tools may help predict postoperative complications in older surgical patients. This study aimed to develop and validate a multivariable risk score for 30-day postoperative complications in patients undergoing elective urological surgery.

Methods

We conducted a prospective cohort study in patients aged ≥70 years scheduled for minor or major elective urologic surgery. Frailty was assessed using Clinical Frailty Scale (CFS) and Short Physical Performance Battery (SPPB), cognitive status with the Mini-Cog test, and major preoperative comorbidities were recorded. The primary outcome was the occurrence of postoperative complications within 30 days, classified according to the European Postoperative Clinical Outcome (EPCO) criteria. Variable selection used stepwise logistic regression with bootstrap validation.

Results

Of 458 patients enrolled, 413 were eligible for analysis. Median age was 78 years (IQR 74-83), and 83% were men. According to ASA classification, 36.6% were ASA II, 57.6% ASA III, and 5.8% ASA IV. Frailty prevalence was 44.8% by SPPB<10 points and 20% by CFS>3. At least one complication occurred in 49.6% of patients. The final risk score identified SPPB<10, age, preoperative haemoglobin, history of stroke, and surgical duration as independent predictors.

Conclusions

A multivariable risk score incorporating SPPB alongside key clinical variables predicts 30-day postoperative complications in older urological patients. SPPB provides valuable objective frailty assessment for preoperative risk stratification.