Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health?

Introduction: Surgical frailty is a previously unrecognized clinical entity that objectifies a multiorgan decrease in physiologic reserve in those undergoing surgery. Although penile implantation has been demonstrated to be an effective means of restoring erectile function in patients whose previous conservative measures have failed, there are limited data regarding the assessment of frailty in patients undergoing penile implantation. Aim: To review the various objective methods used to describe surgical frailty in medical and surgical disciplines, report on methodologies of frailty assessment, and discuss the relevance of surgical frailty in the preoperative evaluation of patients undergoing implantation of an inflatable penile prosthesis. Methods: A literature review was performed through PubMed regarding surgical frailty in the disciplines of medicine, surgery, and urology. Key words and phrases included frailty, elderly, aging, erectile dysfunction, penile implantation, and penile prosthesis. Main Outcome Measure: Critical assessment of frailty in medicine and its application to male prosthetic health. Results: Frailty has been assessed by different metrics in multiple fields. Validated modalities to determine physiologic reserve include an accumulation of deficits and phenotypic objective assessments that are reviewed in detail. Frail patients experience longer length of stay, postoperative complications, unplanned returns to the operating room, and readmissions and are less likely to be discharged to home. Novel frailty assessments objectified through grip strength measurements from our institution demonstrate that a considerable number of patients, young and old, undergoing penile implantation exhibit surgical frailty. Conclusion: There is a growing need to incorporate frailty assessment in the preoperative risk stratification of patients undergoing penile implantation. Grip strength evaluation seems to be an obvious standard because it is likely the easiest to measure and is clinically relevant given the user's dependence on manual dexterity to use the device. Screening for frailty does not create a substantial time, financial, or resource burden for the urologist. Brennan MS, Barlotta RM, Simhan J. Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health? Sex Med Rev 2018;6:302–309.