To evaluate the impact of frailty on adverse perioperative outcomes in patients treated with radical cystectomy for bladder cancer.
We identified 9,459 adults (age ≥18) in the Nationwide Readmission Database (NRD) who underwent radical cystectomy in 2014 for bladder cancer. We defined patients’ frailty status using Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator and compared in-hospital mortality, ICU-level complications, 30-day readmissions, non-home discharge, length of hospitalization, and hospital-related costs between frail and non-frail patients using χ2 tests. We used multivariate logistic regression to identify predictors of the primary outcomes of interest.
Of 9,459 patients undergoing radical cystectomy, 7.1% (n=673) met criteria. Frail patients were more likely than non-frail patients to have comorbid conditions (68.2% vs. 59.7%; p=0.005), in-hospital mortality (4.2% vs. 1.5%; p=0.04), ICU-level complications (52.9% vs. 18.6%; p<0.001), non-home discharge (33.9% vs. 11.6%; p<0.001), longer length of stay (median 15 vs. 7 days; p<0.001), and higher median cost of the index admission ($39,665 vs. $27,307). Frailty was the strongest independent predictor of ICU-level complications, non-home discharge, increased length of stay, and hospital-related costs of any covariate.
Frail patients receiving radical cystectomy were more likely than non-frail patients to have adverse perioperative outcomes and higher odds of in-hospital mortality, ICU-level complications, non-home discharge, increased length of stay, and hospital-related costs. Preoperative consideration of frailty may be useful in clinical guidance and shared decision-making.
Urology. 2019 Jul 12 [Epub ahead of print]
Joaquin Michel, Alexander N Goel, Vishnukamal Golla, Andrew T Lenis, David C Johnson, Karim Chamie, Mark S Litwin
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: ., Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Veterans Affairs/UCLA National Clinician Scholars Program, Los Angeles, California., Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California; UCLA Fielding School of Public Health, Los Angeles, California; UCLA School of Nursing, Los Angeles, California.