Introduction: While frailty has emerged as a predictor of morbidity following urological surgery, it remains difficult to measure. A new frailty index (modified Frailty Index-5(mFI-5)) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH); however, its discriminatory abilities for postoperative complications has not been investigated. Therefore, we compared mFI-5 to two most commonly used indexes, the American Society of Anesthesiologists physical classification (ASA) and modified Charlson Comorbidity Index (mCCI) using the National Surgical Quality Improvement Program (NSQIP) database. Methods: We retrospectively queried the 2015-2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using CPT and ICD codes. Patients were stratified by procedure type (transurethral resection of the prostate (TURP), laser vaporization (LVP) and enucleation (LEP) of the prostate). Risk indexes were calculated and compared as predictors of postoperative outcomes using C-statistics (AUC). Results: 38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%, but upon stratifying by procedure, the complication rates were 11.0%, 10.3%, and 7.6% for TURP, LVP, and LEP, respectively. In aggregate, ASA Class, mFI-5, and mCCI were fair models of mortality (AUC>0.7) and not superior to the other (p>0.05). ASA Class and mCCI were poor models (AUC: 0.6-0.7) for 30-day readmission and surgical complications; however, mFI-5 failed to model either postoperative outcome. All indexes failed to model any other postoperative outcomes (any complication, medical complications, reoperation, disease severity, length of stay =2 days) (AUC <0.6). Upon stratifying by endoscopic procedure, all three indexes remained fair models of mortality (AUC>0.7) and not superior to the other (p>0.05). Likewise, when stratifying by endoscopic procedure, all three indexes remained poor models for any readmissions and surgical complications (AUC>0.6). Conclusions: All three indexes are fair models of mortality for endoscopic treatment of BPH. However, these indexes were inadequate models for all other postoperative outcomes, despite previous studies demonstrating an association. Endoscopic treatment of BPH needs better risk indexes to predict post-operative complications. SOURCE OF Funding: None.
