A Rapid Method to Preoperatively Assess Frailty for Older Patients with Pelvic Floor Conditions

No AccessJournal of UrologyAdult Urology1 Jun 2020A Rapid Method to Preoperatively Assess Frailty for Older Patients with Pelvic Floor Conditions Katherine A. Amin, Wai Lee, Dena Moskowitz, Kathleen C. Kobashi, Alvaro Lucioni, May J. Reed, Michael Nash, and Una J. Lee Katherine A. AminKatherine A. Amin *Correspondence: Department of Urology, Professional Arts Center, 1150 NW 14th St., Suite 309, Miami, Florida 33136 telephone: 305-243-6090; FAX: 305-243-6597; E-mail Address: [email protected] Department of Urology, University of Miami Miller School of Medicine, Miami, Florida , Wai LeeWai Lee Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington , Dena MoskowitzDena Moskowitz Department of Urology, University of California, Irvine, Irvine, California , Kathleen C. KobashiKathleen C. Kobashi Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington , Alvaro LucioniAlvaro Lucioni Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington , May J. ReedMay J. Reed Division of Gerentology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington , Michael NashMichael Nash Department of Statistics, University of Washington, Seattle, Washington , and Una J. LeeUna J. Lee Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington View All Author Informationhttps://doi.org/10.1097/JU.0000000000000739AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Assessment of frailty can help surgeons predict perioperative risk and guide preoperative counseling. However, current methods are often cumbersome in the clinical setting. We prospectively compared the effectiveness of a rapid picture based Clinical Frailty Scale (CFS-9) assessed by patient and surgeon against reference standard Fried Frailty Index in older patients with pelvic floor conditions. Materials and Methods: We enrolled 71 patients between March 2018 and June 2019. Frailty assessment using CFS-9 (scale ranging from very fit to terminally ill) was performed followed by the Fried Frailty Index, a validated tool of 5 measures (shrinking, physical energy, activity, grip strength, walking speed). Correlations and agreement between Fried Frailty Index and CFS-9 scores from the treating surgeon, a second surgeon (surgeon 2) and patient were analyzed using sensitivity, specificity, area under the curve and Cohen's Kappa. Results: The patient cohort was mostly female (97.2%), with a mean age (±SD) of 73.0 (±5.9) years and 23.9% were frail using the Fried Frailty Index. Compared to the Fried Frailty Index, CFS-9 scores of the treating surgeon, surgeon 2 and patient had AUC values (95% CI) of 0.86 (0.77–0.86), 0.91 (0.84–0.91) and 0.88 (0.79–0.88), respectively. As assessed by Cohen's Kappa the CFS-9 scores all had substantial (surgeon 2, Kappa 0.66, 95% CI 0.46—0.85 or moderate (all other CFS-9 measures, Kappa 0.44 to 0.58) agreement with the Fried Frailty Index scores. Conclusions: Rapid and effective validated tools to screen for frailty are needed in the clinical setting. CFS-9 is an excellent predictor of frailty compared to the Fried Frailty Index for patients with pelvic floor conditions. References 1. : Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol 2009; 114: 1278. Google Scholar 2. : Epidemiology and prevalence of pelvic organ prolapse. Curr Opin Urol 2013; 23: 293. Google Scholar 3. : Defining overactive bladder: epidemiology and burden of disease. Urology 2004; 64: 2. 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Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGomelsky A (2020) Editorial CommentJournal of Urology, VOL. 205, NO. 1, (197-197), Online publication date: 1-Jan-2021. Volume 203Issue 6June 2020Page: 1172-1177Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsfrailtytreatment outcomeoperativesurgical proceduresprolapseurinary incontinenceMetricsAuthor Information Katherine A. Amin Department of Urology, University of Miami Miller School of Medicine, Miami, Florida *Correspondence: Department of Urology, Professional Arts Center, 1150 NW 14th St., Suite 309, Miami, Florida 33136 telephone: 305-243-6090; FAX: 305-243-6597; E-mail Address: [email protected] More articles by this author Wai Lee Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington More articles by this author Dena Moskowitz Department of Urology, University of California, Irvine, Irvine, California More articles by this author Kathleen C. Kobashi Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington More articles by this author Alvaro Lucioni Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington More articles by this author May J. Reed Division of Gerentology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington More articles by this author Michael Nash Department of Statistics, University of Washington, Seattle, Washington More articles by this author Una J. Lee Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington Financial interest and/or other relationship with Medtronic. More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...