Low free testosterone is associated with increased mortality in frail surgical patients

Fangyi Lin; Gordon Hong; Frances Kwon; Farha Pirani; Salima Makhani; Mark Henry; Ian Cooke; Reza Nabavizadeh; Eric Midenberg; Akanksha Mehta; Chad Ritenour; Viraj A Master; Kenneth Ogan

doi:10.1016/j.sopen.2021.11.002

Low free testosterone is associated with increased mortality in frail surgical patients

Surg Open Sci. 2021 Nov 14:7:36-41. doi: 10.1016/j.sopen.2021.11.002. eCollection 2022 Jan.

Authors

Affiliations

¹ Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
² Northeast Ohio Medical University, Rootstown, OH, USA.
³ Medical College of Georgia, Augusta, GA, USA.
⁴ Mercer University School of Medicine, Macon, GA, USA.

Abstract

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.

Keywords: ASA, American Society of Anesthesiologists; BMI, body mass index; CCI, Charlson Comorbidity Index; CI, confidence interval; ECOG, Eastern COoperative Oncology Group; HR, hazard ratio; IQR, interquartile range; OS, overall survival; T, testosterone; eGFR, estimated Glomerular Filtration Rate.