Low testosterone and frailty linked with 180-day readmission in men undergoing TURP, PVP

In this video, Jasmine Lin, MD, discusses the background and notable findings from the study, “Association between low testosterone and perioperative outcomes in patients undergoing transurethral prostate surgery,” which was presented at the American Urological Association 2023 Annual Meeting in Chicago, Illinois. Lin is a urology resident at Cedars-Sinai in Los Angeles, California.

Transcription

Please discuss the background for this study.

In developing this study, we reasoned that given the significant prevalence of low testosterone in the general population, especially in older men, a large proportion of men undergoing transurethral procedures for BPH are likely to have low testosterone. Now, we know from prior research that low T is associated with anemia, decreased muscle mass, frailty, risk of cardiovascular disease, and just overall lower health-related quality of life. So we hypothesized that low T might adversely affect perioperative outcomes for patients undergoing surgical procedures, particularly transurethral resection of the prostate and laser photo vaporization of the prostate. So we sought to characterize the prevalence of low T as well as the association between low T, frailty, and perioperative outcomes in these patients.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

We performed a retrospective evaluation of men across Northwestern's integrated health care system of patients who underwent TURP or PVP and had a recorded T level within a year prior to their procedure date. We defined low T using the cutoff of 300 ng/dL according to AUA guidelines. And then we compared it to these 2 groups and perform progressions to evaluate the association between low T, frailty, and specific peri-op outcomes. And what we found was among the 181 patients in our study who underwent either TURP or PVP, almost half, 49%, had low T, and these patients were significantly older, they had longer post-op stays, significantly lower post-op hemoglobin and hematocrit, and they also had significantly higher rates of readmission within 180 days: 28% vs 13%. Surprisingly, T was not independently associated with frailty on our analysis, but on multivariable analysis, both hospital frailty risk score and low preoperative T were independently associated with 180-day readmission.

This transcript was edited for clarity.