The Role of Frailty on Surgical Outcomes Following Pelvic Organ Prolapse Surgery in Medicare Beneficiaries: A National Study

OBJECTIVE To evaluate the association of frailty with surgical outcomes following pelvic organ prolapse (POP) surgery in Medicare beneficiaries. METHODS This is a retrospective cohort study of female Medicare beneficiaries >= 65 years of age undergoing POP surgery between 2014 and 2016. Primary outcomes were hospital length-of-stay (LOS) >= 3 days, 30-day post-operative complications (excluding urinary tract infections (UTI)), and 30day UTI. Frailty was quantified using the validated Claims-Based Frailty Index (CFI) and categorized into not frail (CFI<0.15), pre-frail (0.15 <= CFI <= 0.25), and moderately to severely frail (0.35 <= CFI <= 1). RESULTS Among the 107,890 women included (mean age, 73.3 +/- 6 years), 91.3% were White as and 4.3% were classified as mildly or moderately to severely frail. Rates of hospital LOS >= 3 days and 30-day UTI increased over 7-fold and rates of 30-day complications increased over 3-fold as CFI increased from not frail to moderately to severely frail (all P values <.001). Compared to women who were not frail, women who were moderately to severely frail demonstrated an increased relative risk of hospital LOS >= 3 days (aRR 3.1 [95% CI 2.5-3.8,P <.0011), 30-day complications (aRR 2.8 [95% CI 2.2-3.6, P <.0011), and 30-day UTI (aRR 2.5 [95% CI 2.2-3.0, P <.0011). CONCLUSION Among Medicare beneficiaries undergoing POP surgery in the United States, frailty is strongly associated with increased risk of prolonged hospital stay and 30-day complications. Frailty should be considered in the preoperative assessment for POP surgeries to improve patient outcomes. (C) 2022 Elsevier Inc.