(091) The Association Between Hypogonadism, Frailty, and Postoperative Outcomes Among Men Undergoing Radical Cystectomy
Authors: Greenberg D , Bhambhvani H , Gago L , Rhodes S , Schaeffer E , Meeks J , Brannigan R , Shoag J , Halpern J 
Published: February 2024

Abstract

Introduction
Hypogonadism is associated with frailty, lower health-related quality of life, decreased muscle mass, and premature mortality, which may predispose patients to poor postoperative outcomes. However, the prevalence and importance of hypogonadism and frailty among men undergoing radical cystectomy (RC) remains unknown.

Objective
We aimed to determine the prevalence of hypogonadism in men undergoing RC and whether hypogonadism and frailty are associated with adverse postoperative outcomes in this population.

Methods
We utilized the IBM Marketscan database, which contains information on inpatient admissions, outpatient encounters, and outpatient prescriptions from Commercial and Medicare plans. Inpatient admissions were used to identify men who underwent RC between 2012-2021. Frailty was coded using diagnosis codes available in the year prior to RC and categorized as low-, intermediate-, or high-risk using published Hospital Frailty Risk Score (HFRS) ranges. Patients were considered to have hypogonadism if they had a diagnosis in the 5 years prior to RC. Demographics and surgical outcomes including length of stay (LOS), complications, and rate of 90-day ED visits and 90-day inpatient readmissions were collected. Sub-group analysis was also performed among men with hypogonadism to determine the effect of testosterone replacement therapy (TRT) on clinical outcomes. Differences in baseline characteristics between hypogonadism and control cohorts were assessed via Kruskal Wallis and Chi-squared tests, as appropriate. Multivariable Cox proportional hazards models were used to assess the association between hypogonadism and frailty and the rate of ED visits or inpatient readmissions following RC. To focus on post-RC events, patients without an ED visit or readmission were censored at 90 days. Significance was determined using p&lt;0.05.

Results
Among 3,729 men who underwent RC, 228 (6.1%) had a diagnosis of hypogonadism within 5 years prior to RC. Overall, 564 (15.1%) men were categorized as low-risk frailty, 2,216 (59.4%) were intermediate-risk frailty, and 949 (25.4%) were high-risk frailty. Men with hypogonadism were significantly more frail compared to men without hypogonadism (p=0.001). There was no significant difference in age, LOS, postoperative complications, ED visits, or rate of inpatient readmissions between cohorts (p&gt;0.05). However, high-risk frailty was independently associated with an increased risk of ED visit (HR 1.29, 95% CI [1.09-1.52], p=0.003) and inpatient readmissions (HR 1.55, 95% CI [1.27-1.89], p&lt;0.001) following RC. On sub-group analysis of men with hypogonadism, 48 (21.1%) had a prescription for TRT within 5 years prior to RC. There was no difference in demographics, frailty, LOS, complications, or 90-day ED visits or 90-day inpatient readmissions between groups. Among men with hypogonadism, high-risk frailty was also associated with increased risk of inpatient readmission (HR 1.45, 95% CI [1.03-2.04], p=0.03).

Conclusions
Hypogonadism was associated with worse preoperative frailty, but was not independently associated with poor postoperative outcomes among men undergoing RC. However, high-risk frailty was associated with increased odds of postoperative ED visits and inpatient readmission. While prospective data is required to validate our results, these findings suggest that both hypogonadism and preoperative frailty should be evaluated prior to undergoing RC.

Disclosure
No.