Preoperative frailty predicts adverse short-term postoperative outcomes in patients treated with radical nephroureterectomy

Giuseppe Rosiello, Carlotta Palumbo, Marina Deuker, Lara Franziska Stolzenbach, Zhe Tian, Alessandro Larcher, Umberto Capitanio, Francesco Montorsi, Shahrokh F. Shariat, Anil Kapoor, Fred Saad, Alberto Briganti, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review


Background: To investigate the effect of frailty on short-term postoperative outcomes and total hospital charges (THCs) in patients with non-metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU). Methods: Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000-2015). We used the Johns Hopkins frailty-indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied. Results: Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P <.001). Frail patients exhibited higher rates (all P <.05) of overall complications (62.6% vs 50.9%), in-hospital mortality (1.6% vs 1.0%), non-home–based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P <.05) overall complications (OR, 1.46), in-hospital mortality (OR, 1.52), non-home–based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806). Conclusion: Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short-term postoperative complications, as well as longer LOS and higher THCs after RNU.

Original languageEnglish
Pages (from-to)688-696
Number of pages9
JournalJournal of Surgical Oncology
Issue number4
Publication statusPublished - Mar 1 2020


  • hospital costs
  • Johns Hopkins frailty indicator
  • National Inpatient Sample database
  • postoperative complications
  • upper urinary tract carcinoma

ASJC Scopus subject areas

  • Surgery
  • Oncology


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