Frailty is a predictor of moderate to severe pain after robot-assisted laparoscopic prostatectomy: A case-control study (FRAP study)

Abstract

Objective: To investigate the association of pain with frailty in patients with localized prostate cancer (PC) who underwent robot-assisted laparoscopic radical prostatectomy (RARP).

Materials and methods: Between January 2017 and June 2019, we prospectively evaluated the geriatric 8 (G8) score, simplified frailty index (sFI), and numerical rating scale (NRS) of 154 patients with localized PC who underwent RARP at our institution. NRS was measured on preoperative day 0, postoperative days 1, 2, 3, and at discharge. Moderate to severe pain was defined as NRS ≥ 5, whereas frailty was defined as G8 ≤ 14. The primary objectives of this study were to investigate the effects of moderate to severe pain (NRS ≥ 5) on frailty, postoperative complications, and the use of analgesics after RARP. Our secondary objectives were the effect of frailty on postoperative complications and the use of analgesics.

Results: The median age of participants was 69 years. Of 154 patients, 37 (24%) and 61 (40%) were classified to have NRS ≥ 5 and G8 ≤ 14, respectively. Patients with NRS > 5 presented significantly association with G8 < 14, whereas they did not show the association with sFI, complication, or analgesics. Multivariate logistic regression analysis showed that G8 ≤ 14 was significantly associated with NRS ≥ 5. Frailty was not significantly associated with postoperative complications and analgesics.

Conclusions: Frailty was significantly associated with moderate to severe pain after RARP, and might be a potential predictor of postoperative pain. Frail patients require individual care to avoid painful experiences.

Keywords: frailty; geriatric 8; pain; prostate cancer; prostatectomy.

Figure 1

Primary outcomes measure. The effect of the numerical rating scale (NRS) on geriatric 8 (G8) (A), simplified frailty index (sFI) (B), postoperative complications (any grades) (C), and the use of analgesics (D) were investigated. Multivariate logistic regression analysis was performed to investigate the association of multiple variables on NRS ≥ 5 (E)

Figure 2

Secondary outcomes measure. The effect of geriatric 8 (G8) on postoperative complications (any grades) (A) and use of analgesics (B) were investigated. The effect of sFI 2–5 on postoperative complications (any grades) (C) and use of analgesics (D) were investigated

Figure 3

Exploratory outcome. The association between frailty and time‐dependent change of numerical rating scale (NRS) was investigated in geriatric 8 (G8) (A) and simplified frailty index (sFI) (B). The association between maximum NRS (maximum pain) and total NRS (total pain) was also evaluated (C). The linear association between the total NRS and maximum NRS (D), between maximum NRS and G8 (E), between maximum NRS and sFI (F) were evaluated. The optimal cutoff value of G8 for NRS ≥ 5 was evaluated using receiver operating characteristic (ROC) curve and the area under the curve (AUC) (E)