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Predicting Short-Term Outcomes After Radical Cystectomy Based on Frailty

Published: July 12, 2019
Category: Bibliography
Authors: Alexander N. Goel BA, Andrew T. Lenis MD MS, David C. Johnson MD MPH, Joaquin Michel BS, Karim Chamie MD MSHS, Mark S. Litwin MD MPH, Vishnukamal Golla MD MPH
Country: USA
Language: English
Types: Acute care intervention, Care Management, Population Health
Settings: Hospital, Specialist

Abstract

Objective

To evaluate the impact of frailty on adverse perioperative outcomes in patients treated with radical cystectomy for bladder cancer.

Material and Methods

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.

Results

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.

Conclusion

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

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