Open Access

ARTICLE

Hypogonadism, frailty, and postoperative outcomes among men undergoing partial nephrectomy

Alon Lazarovich¹, Daniel R. Greenberg², Stephen P. Rhodes³, Hriday P. Bhambhvani⁴, Luis C. Gago², Hiten D. Patel², Robert E. Brannigan², Jonathan E. Shoag⁵, Joshua A. Halpern²

1 Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
2 Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
3 University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
4 Department of Urology, Weill Cornell Medicine James Buchanan Brady Foundation, New York, New York, USA
5 Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Address correspondence to Dr. Alon Lazarovich, alon.lazarovich@gmail.com

Canadian Journal of Urology 2024, 31(6), 12045-12052.

Abstract

Introduction: To determine the prevalence of hypogonadism in men undergoing partial nephrectomy (PN) and whether hypogonadism and frailty are associated with adverse postoperative outcomes.
Materials and methods: We identified men undergoing PN between 2012-2021 using the Merative Marketscan database. Patients were considered to have hypogonadism if diagnosed within 5 years prior to PN. Frailty was determined using the Hospital Frailty Risk Score (HFRS). Length of stay (LOS), complications, ED visits, and inpatient readmissions were compared. Sub-group analysis of men with hypogonadism was performed to determine if testosterone replacement therapy (TRT) improved clinical outcomes.
Results: Among 9,105 men who underwent PN, 809 (8.9%) were hypogonadal prior to PN. Hypogonadal men were significantly more frail compared to eugonadal men (HFRS score: median 6.7, IQR 4.1-10.1 vs. median 5.6, IQR 3.3-8.8, p < 0.001). However, there was no significant difference in LOS following PN nor in 90-day postoperative complications, ED visits, or inpatient readmission between men with and without hypogonadism. However, intermediate- and high-risk frailty were associated with increased risk of 90-day ED visits and 90-day inpatient readmission compared to low-risk patients. Among high risk men with hypogonadism, TRT was associated with decreased risk of 90-day ED visits (p = 0.04).
Conclusions: Frailty was associated with postoperative outcomes following PN. Hypogonadism was associated with frailty, and treatment of hypogonadal men with TRT was associated with reduction in post-operative risk. These findings suggest a role for frailty assessment, and possibly testosterone screening, in men undergoing PN.

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