Low free testosterone is associated with increased mortality in frail surgical patients
Autor: | Mark Henry, Farha Pirani, Fangyi Lin, Gordon Hong, Viraj A. Master, Chad W.M. Ritenour, Ian Cooke, Akanksha Mehta, Salima S. Makhani, Frances Kwon, Eric Midenberg, Reza Nabavizadeh, Kenneth Ogan |
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Jazyk: | angličtina |
Rok vydání: | 2022 |
Předmět: |
medicine.medical_specialty
Multivariate analysis RD1-811 BMI body mass index Logistic regression OS overall survival T testosterone Internal medicine medicine In patient Cognitive decline IQR interquartile range eGFR estimated Glomerular Filtration Rate Free testosterone CCI Charlson Comorbidity Index business.industry ASA American Society of Anesthesiologists Testosterone (patch) HR hazard ratio CI confidence interval Cohort ECOG Eastern COoperative Oncology Group Original Article Surgery business Surgical patients |
Zdroj: | Surgery Open Science, Vol 7, Iss, Pp 36-41 (2022) Surgery Open Science |
ISSN: | 2589-8450 |
Popis: | Background Preoperative frailty has been associated with adverse postoperative outcomes. Additionally, low testosterone has been associated with physical frailty and cognitive decline. However, the impact of simultaneous frailty and low testosterone on surgical outcomes is understudied. Methods Preoperative frailty status and testosterone levels were obtained in patients undergoing a diverse range of surgical procedures. Preoperative frailty was evaluated independently and in combination with testosterone through the creation of composite risk groups. Relationships between preoperative frailty and composite risk groups with overall survival were determined using Kaplan–Meier and logistic regression analyses. Bivariate analysis was used to determine the associations between frailty and testosterone status on postoperative complications, length of hospital stay, and readmission rates. Results Median age of the cohort was 63 years, and the median follow-up time was 105 weeks. Thirty-one patients (23%) were frail, and 36 (27%) had low free testosterone. Bivariate analysis demonstrated a statistically significant relationship between preoperative frailty and overall survival (P = .044). In multivariate analysis, coexisting frailty and low free testosterone were significantly associated with decreased overall survival (hazard ratio 4.93, 95% confidence interval, 1.68–14.46, P = .004). Conclusion We observed preoperative frailty, both independently and in combination with low free testosterone levels, to be significantly associated with decreased overall survival across various surgical procedures. Personalizing the surgical risk assessment through the incorporation of preoperative frailty and testosterone status may serve to improve the prognostication of patients undergoing major surgery. Highlights • Both frailty (P = .015) and low free testosterone (P = .005) were independently associated with 1-year mortality. • After stratifying our cohort into 4 composite groups based on frailty and testosterone status, frail patients with low free T had the shortest overall survival when compared to the reference group, with nearly a 5-fold higher risk of death. |
Databáze: | OpenAIRE |
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