Northwestern University, Feinberg School of Medicine
Introduction: Low testosterone (T) is highly prevalent in the male population and is associated with frailty, decreased muscle mass, lower health-related quality of life, and premature mortality, which may predispose patients to poor perioperative outcomes. However, the prevalence and importance of low T and frailty among men undergoing transurethral resection of bladder tumor (TURBT) remains unknown. We aimed to determine if low T and frailty are associated with adverse postoperative outcomes in this population. Methods: We reviewed men who underwent TURBT who had a preoperative T value <1 year prior to surgery. Low T was defined as total T <300 ng/dL and frailty was categorized as low-, intermediate-, or high-risk using published Hospital Frailty Risk Score (HFRS) ranges. Demographics and surgical outcomes including length of stay, postoperative laboratory values and complications, and ED visits, readmissions, and mortality rates were collected. Student’s t test and Fisher’s exact test were used to determine differences between low T and normal T cohorts, and univariate and multivariate logistic regression was used to determine the association of low T and frailty on postoperative outcomes. Results: Among 308 men, 64.6% had low T. Mean preoperative T in the low T cohort was 164.2 ± 98.3 ng/dL vs 414.9 ± 165.3 in the normal T cohort (p < 0.001). Overall, 156 (50.6%) men were categorized as low-risk frailty, 108 (35.1%) were intermediate-risk frailty, and 44 (14.3%) were high-risk frailty, with no difference between cohorts (p=0.45). There was no difference in age, race, ED visits, readmissions, or mortality rates between groups. Men with low T had lower postoperative hemoglobin (12.9 ± 2.0 vs 13.6 ± 1.7, p=0.048) and hematocrit (38.7 ± 5.8 vs 40.0 ± 4.8, p=0.046) compared to men with normal T. T was not associated with frailty (p=0.40), however, high-risk frailty was associated with higher postoperative complications on both univariate (OR 3.2, 95% CI [1.3-8.0], p=0.01) and multivariate logistic regression (OR 3.1, 95% CI [1.2-7.8], p=0.02). Conclusions: The prevalence of low T in men undergoing TURBT was high and was associated with lower postoperative hemoglobin and hematocrit. Although T was not independently associated with frailty, high-risk frailty was associated with increased odds of postoperative complications. While prospective data is required to validate our results, these findings suggest that both T and preoperative frailty should be evaluated prior to undergoing TURBT. SOURCE OF Funding: Urology Care Foundation Research Scholar Award SP0071384
