Risk calculator guides prognostication in older adults with BOO undergoing surgery

A novel risk assessment tool, the UroARC Surgical Calculator, can help physicians in surgical decision-making for older adults undergoing surgery for bladder outlet obstruction (BOO), reports a study. 

Researchers identified and analysed Medicare beneficiaries undergoing BOO surgery from 2014 to 2016 using the Medicare MedPAR, Outpatient, and Carrier files. They then developed eight different BOO surgery categories. 

Using the Claims-Based Frailty Index (CFI), researchers calculated the baseline frailty for each beneficiary. All 93 variables in the CFI and the 17 variables in the Charlson Comorbidity Index were included in the stepwise logistic regression models to determine the predictors of complications. Similar and duplicative variables were merged into categories. 

Finally, the research team calculated the calibration curves and tests of model fit, including C statistics, Brier scores, and Spiegelhalter p-values, to validate the accuracy for postoperative complications. 

A total of 212,543 beneficiaries were identified, of whom 42.15 percent were prefrail (0.15 ≤ CFI < 0.25), 8.7 percent were mildly frail (0.25 ≤ CFI <0.35), and 1.2 percent were moderately to severely frail (CFI ≥0.35).  

Logistic regression analysis revealed 13 distinct prognostic variable categories as the most reliable predictors of postoperative outcomes. Most models had excellent discrimination and calibration, with high C statistic and Spiegelhalter p values, respectively, and high accuracy with low Brier scores. In addition, calibration curves for each outcome had excellent model fit. 

“BOO is common in older adults,” the researchers said. “Many older adults who pursue surgery have additional vulnerabilities affecting surgical risk, including frailty.”