UroARC: A Novel Surgical Risk Calculator for Older Adults Undergoing Suprapubic Tube Placement - 24/10/24

Doi : 10.1016/j.urology.2024.10.007

Farnoosh Nik-Ahd ^a,^⁎ , Shoujun Zhao ^a, Lufan Wang ^a, W. John Boscardin ^b, Kenneth Covinsky ^c, Anne M. Suskind ^a
^a Department of Urology, University of California, San Francisco, San Francisco, CA
^b Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
^c Department of Geriatrics, University of California, San Francisco, San Francisco, CA

^⁎Address correspondence to: Farnoosh Nik-Ahd, M.D., University of California, San Francisco, Mission Hall Global Health Sci Bldg, 550 16th Street, 6th floor, Box 1695, San Francisco, CA 94143.University of California, San Francisco, Mission Hall Global Health Sci Bldg550 16th Street, 6th floor, Box 1695San FranciscoCA94143

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 24 October 2024

Résumé

Objective

To develop a surgical risk calculator for older adults undergoing suprapubic tube (SPT) placement that specifically factors in frailty, a key predictor of surgical risk in this vulnerable and heterogenous population.

Methods

Medicare MedPAR, Outpatient, and Carrier files for beneficiaries undergoing SPT placement between 2014-2016 were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty, was used to calculate baseline frailty for each beneficiary. Stepwise regression models were used for each variable within the CFI and Charlson Comorbidity Index to determine the variables most highly predictive of postoperative complications. The most highly predictive variables were then combined into parsimonious categories. To ensure the prognostic accuracy for each outcome, calibration curves and tests of model fit, including C-statistics, Brier scores, and Spiegelhalter P-values were calculated.

Results

A total of 26,999 beneficiaries were included. Among these, 39.1% were pre-frail, 36.8% were mildly frail, and 12.3% were moderately to severely frail. Thirteen prognostic variable categories were deemed highly predictive of postoperative complications of interest. All models demonstrated low Brier scores, indicating high model accuracy, and high C-statistic and Spiegelhalter P-values, consistent with excellent model discrimination and calibration, respectively. Excellent model fit was seen on calibration curves for each outcome.

Conclusion

UroARC is a novel surgical tool for older adults undergoing SPT placement that specifically factors in frailty. This risk calculator has high accuracy, calibration, and discrimination, and serves as a valuable resource to patients and clinicians for those undergoing consideration for SPT placement.

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