Abstract：
OBJECTIVE: Hypogonadism and frailty may impact postoperative outcomes for men undergoing radical nephrectomy (RN). We aimed to determine the prevalence of hypogonadism in men undergoing RN and whether hypogonadism and frailty are associated with adverse postoperative outcomes.
METHODS: We identified men undergoing RN between 2012 and 2021 using the IBM Marketscan database. Frailty was determined using the Hospital Frailty Risk Score (HFRS). Patients were considered to have hypogonadism if diagnosed <5 years before RN. Length of stay (LOS), complications, emergency department (ED) visits, and readmissions were evaluated between men with and without hypogonadism at the time of surgery. Subgroup analysis of men with hypogonadism was performed to determine the effect of testosterone replacement therapy (TRT) on clinical outcomes.
RESULTS: Among 13 598 men who underwent RN, 972 (7.1%) had hypogonadism. Men with hypogonadism were more frail compared to men without hypogonadism (HFRS: median: 8.2, interquartile range [IQR]: 5.2-11.7 vs. median: 7.0, IQR: 4.3-10.7, p < 0.001) and had increased incidence of postoperative ileus (13.0% vs. 10.8%, p = 0.045), acute kidney injury (25.5% vs. 21.6% p = 0.005), and cardiac arrest (1.2% vs. 0.6%, p = 0.034). Hypogonadism was not associated with LOS, 90-day ED visit or readmission. However, high-risk frailty was associated with increased risk of 90-day ED visit (hazard ratio [HR]: 2.1, 95% confidence interval [95% CI]: 1.9-2.4, p < 0.001) and 90-day inpatient readmission (HR: 2.6, 95% CI: 2.2-3.1, p < 0.001), compared to low-risk frailty patients. Among men with hypogonadism, TRT was not associated with any postoperative outcomes.
CONCLUSIONS: Hypogonadism and frailty should be considered in the preoperative evaluation for men undergoing RN as risk factors for adverse postoperative outcomes.
METHODS: We identified men undergoing RN between 2012 and 2021 using the IBM Marketscan database. Frailty was determined using the Hospital Frailty Risk Score (HFRS). Patients were considered to have hypogonadism if diagnosed <5 years before RN. Length of stay (LOS), complications, emergency department (ED) visits, and readmissions were evaluated between men with and without hypogonadism at the time of surgery. Subgroup analysis of men with hypogonadism was performed to determine the effect of testosterone replacement therapy (TRT) on clinical outcomes.
RESULTS: Among 13 598 men who underwent RN, 972 (7.1%) had hypogonadism. Men with hypogonadism were more frail compared to men without hypogonadism (HFRS: median: 8.2, interquartile range [IQR]: 5.2-11.7 vs. median: 7.0, IQR: 4.3-10.7, p < 0.001) and had increased incidence of postoperative ileus (13.0% vs. 10.8%, p = 0.045), acute kidney injury (25.5% vs. 21.6% p = 0.005), and cardiac arrest (1.2% vs. 0.6%, p = 0.034). Hypogonadism was not associated with LOS, 90-day ED visit or readmission. However, high-risk frailty was associated with increased risk of 90-day ED visit (hazard ratio [HR]: 2.1, 95% confidence interval [95% CI]: 1.9-2.4, p < 0.001) and 90-day inpatient readmission (HR: 2.6, 95% CI: 2.2-3.1, p < 0.001), compared to low-risk frailty patients. Among men with hypogonadism, TRT was not associated with any postoperative outcomes.
CONCLUSIONS: Hypogonadism and frailty should be considered in the preoperative evaluation for men undergoing RN as risk factors for adverse postoperative outcomes.
摘要：
目的：性腺功能减退和虚弱可能影响接受根治性肾切除术（RN）的男性患者的术后结局。我们旨在确定接受RN的男性性腺功能减退的患病率，以及性腺功能减退和虚弱是否与术后不良结局相关。
方法：我们使用IBMMarketscan数据库确定了在2012年至2021年期间接受RN的男性。使用医院虚弱风险评分(HFRS)确定虚弱。如果在RN前<5年被诊断，则认为患者患有性腺功能减退症。逗留时间(LOS)并发症,急诊科（ED）访问，在手术时评估有和无性腺功能减退症的男性之间的再入院率.对男性性腺功能减退症患者进行亚组分析，以确定睾酮替代疗法（TRT）对临床结局的影响。
结果：在13598名接受RN的男性中，972（7.1％）患有性腺机能减退。与没有性腺机能减退的男性相比，患有性腺机能减退的男性更虚弱（HFRS：中位数：8.2，四分位数间距[IQR]：5.2-11.7vs.中位数：7.0，IQR：4.3-10.7，p<0.001），术后肠梗阻发生率增加（13.0%vs.10.8%,p=0.045),急性肾损伤（25.5%vs.21.6%p=0.005)，和心脏骤停(1.2%vs.0.6%，p=0.034)。性腺功能减退与LOS无关，90天ED访视或再入院。然而,高风险虚弱与90天ED访视的风险增加相关（风险比[HR]：2.1，95％置信区间[95％CI]：1.9-2.4，p<0.001）和90天住院患者再入院（HR：2.6，95％CI：2.2-3.1，p<0.001），与低风险虚弱患者相比。在性腺功能减退的男性中，TRT与任何术后结果无关。
结论：在接受RN的男性的术前评估中，应将性腺功能减退和虚弱视为术后不良结局的危险因素。
方法：我们使用IBMMarketscan数据库确定了在2012年至2021年期间接受RN的男性。使用医院虚弱风险评分(HFRS)确定虚弱。如果在RN前<5年被诊断，则认为患者患有性腺功能减退症。逗留时间(LOS)并发症,急诊科（ED）访问，在手术时评估有和无性腺功能减退症的男性之间的再入院率.对男性性腺功能减退症患者进行亚组分析，以确定睾酮替代疗法（TRT）对临床结局的影响。
结果：在13598名接受RN的男性中，972（7.1％）患有性腺机能减退。与没有性腺机能减退的男性相比，患有性腺机能减退的男性更虚弱（HFRS：中位数：8.2，四分位数间距[IQR]：5.2-11.7vs.中位数：7.0，IQR：4.3-10.7，p<0.001），术后肠梗阻发生率增加（13.0%vs.10.8%,p=0.045),急性肾损伤（25.5%vs.21.6%p=0.005)，和心脏骤停(1.2%vs.0.6%，p=0.034)。性腺功能减退与LOS无关，90天ED访视或再入院。然而,高风险虚弱与90天ED访视的风险增加相关（风险比[HR]：2.1，95％置信区间[95％CI]：1.9-2.4，p<0.001）和90天住院患者再入院（HR：2.6，95％CI：2.2-3.1，p<0.001），与低风险虚弱患者相比。在性腺功能减退的男性中，TRT与任何术后结果无关。
结论：在接受RN的男性的术前评估中，应将性腺功能减退和虚弱视为术后不良结局的危险因素。
