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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.

frailty, radical cystectomy, bladder cancer, readmissions, Nationwide Readmissions Database