Abstract
Background: The purpose of this study was to assess patient frailty as a risk factor for radical cystectomy (RC) complications. Materials and Methods: We performed an analysis of prospectively collected data of consecutive patients 80 years of age or older who underwent RC and ureterocutaneostomy in 6 primary care European urology centers. Frailty was measured using a simplified frailty index (sFI) with a 5-item score including: (1) diabetes mellitus; (2) functional status; (3) chronic obstructive pulmonary disease; (4) congestive cardiac failure; and (5) hypertension, with a maximum 5-item score meaning high level of frailty. Within 90 days surgical complications were scored according to the Clavien Classification System (CCS). sFI ≥3 was considered as poor frailty status. Clinical and pathological variables were analyzed as predictors of severe complications (CCS ≥3). Results: One hundred seventeen patients were enrolled. Most patients reported an sFI score of 2 and 3, respectively, 31/117 (26.5%) and 45/117 patients (38.5%). CCS ≥3 occurred in 17/117 patients (14.5%). Patients with sFI ≥3 were significantly older than patients with sFI <3 (median age, 85 years [interquartile range (IQR), 82-86] versus 82 years [IQR, 80-84]; P =. 001). Most CCS ≥3 scores occurred in patients with sFI ≥3: 13 (11.1%) versus 4 (3.4%; P =. 02). No significative differences were detected in terms of length of hospital stay, pathological stage, and postoperative bowel canalization when related to sFI. sFI ≥3 was an independent risk factor of CCS ≥3 in univariate and multivariate analysis (respectively, odds ratio [OR], 3.81 [95% confidence interval (CI), 1.16-12.5; P =. 02] and OR, 3.1 [95% CI, 0.7-13.7; P =. 01]). Body mass index, age, American Society of Anesthesiologists score ≥3, and pathological stage were not related to CCS ≥3. Conclusion: RC appears feasible in elderly patients with an sFI <3. In cases of sFI ≥3, this choice should be carefully valued, discussed, and possibly avoided because of a higher risk of complications.
| Original language | English |
|---|---|
| Pages (from-to) | 402-407 |
| Number of pages | 6 |
| Journal | Clinical Genitourinary Cancer |
| Volume | 17 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Oct 1 2019 |
Fingerprint
Keywords
- Bladder cancer
- Elderly
- Fraily
- Radical cystectomy
- Ureterocutaneostomy
ASJC Scopus subject areas
- Oncology
- Urology
Cite this
Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy : The Role of the Frailty Index. / De Nunzio, Cosimo; Cicione, Antonio; Izquierdo, Laura; Lombardo, Riccardo; Tema, Giorgia; Lotrecchiano, Giuseppe; Minervini, Andrea; Simone, Giuseppe; Cindolo, Luca; D'Orta, Carlo; Ajami, Tarek; Antonelli, Alessandro; Dellabella, Marco; Alcaraz, Antonio; Tubaro, Andrea.
In: Clinical Genitourinary Cancer, Vol. 17, No. 5, 01.10.2019, p. 402-407.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy
T2 - The Role of the Frailty Index
AU - De Nunzio, Cosimo
AU - Cicione, Antonio
AU - Izquierdo, Laura
AU - Lombardo, Riccardo
AU - Tema, Giorgia
AU - Lotrecchiano, Giuseppe
AU - Minervini, Andrea
AU - Simone, Giuseppe
AU - Cindolo, Luca
AU - D'Orta, Carlo
AU - Ajami, Tarek
AU - Antonelli, Alessandro
AU - Dellabella, Marco
AU - Alcaraz, Antonio
AU - Tubaro, Andrea
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: The purpose of this study was to assess patient frailty as a risk factor for radical cystectomy (RC) complications. Materials and Methods: We performed an analysis of prospectively collected data of consecutive patients 80 years of age or older who underwent RC and ureterocutaneostomy in 6 primary care European urology centers. Frailty was measured using a simplified frailty index (sFI) with a 5-item score including: (1) diabetes mellitus; (2) functional status; (3) chronic obstructive pulmonary disease; (4) congestive cardiac failure; and (5) hypertension, with a maximum 5-item score meaning high level of frailty. Within 90 days surgical complications were scored according to the Clavien Classification System (CCS). sFI ≥3 was considered as poor frailty status. Clinical and pathological variables were analyzed as predictors of severe complications (CCS ≥3). Results: One hundred seventeen patients were enrolled. Most patients reported an sFI score of 2 and 3, respectively, 31/117 (26.5%) and 45/117 patients (38.5%). CCS ≥3 occurred in 17/117 patients (14.5%). Patients with sFI ≥3 were significantly older than patients with sFI <3 (median age, 85 years [interquartile range (IQR), 82-86] versus 82 years [IQR, 80-84]; P =. 001). Most CCS ≥3 scores occurred in patients with sFI ≥3: 13 (11.1%) versus 4 (3.4%; P =. 02). No significative differences were detected in terms of length of hospital stay, pathological stage, and postoperative bowel canalization when related to sFI. sFI ≥3 was an independent risk factor of CCS ≥3 in univariate and multivariate analysis (respectively, odds ratio [OR], 3.81 [95% confidence interval (CI), 1.16-12.5; P =. 02] and OR, 3.1 [95% CI, 0.7-13.7; P =. 01]). Body mass index, age, American Society of Anesthesiologists score ≥3, and pathological stage were not related to CCS ≥3. Conclusion: RC appears feasible in elderly patients with an sFI <3. In cases of sFI ≥3, this choice should be carefully valued, discussed, and possibly avoided because of a higher risk of complications.
AB - Background: The purpose of this study was to assess patient frailty as a risk factor for radical cystectomy (RC) complications. Materials and Methods: We performed an analysis of prospectively collected data of consecutive patients 80 years of age or older who underwent RC and ureterocutaneostomy in 6 primary care European urology centers. Frailty was measured using a simplified frailty index (sFI) with a 5-item score including: (1) diabetes mellitus; (2) functional status; (3) chronic obstructive pulmonary disease; (4) congestive cardiac failure; and (5) hypertension, with a maximum 5-item score meaning high level of frailty. Within 90 days surgical complications were scored according to the Clavien Classification System (CCS). sFI ≥3 was considered as poor frailty status. Clinical and pathological variables were analyzed as predictors of severe complications (CCS ≥3). Results: One hundred seventeen patients were enrolled. Most patients reported an sFI score of 2 and 3, respectively, 31/117 (26.5%) and 45/117 patients (38.5%). CCS ≥3 occurred in 17/117 patients (14.5%). Patients with sFI ≥3 were significantly older than patients with sFI <3 (median age, 85 years [interquartile range (IQR), 82-86] versus 82 years [IQR, 80-84]; P =. 001). Most CCS ≥3 scores occurred in patients with sFI ≥3: 13 (11.1%) versus 4 (3.4%; P =. 02). No significative differences were detected in terms of length of hospital stay, pathological stage, and postoperative bowel canalization when related to sFI. sFI ≥3 was an independent risk factor of CCS ≥3 in univariate and multivariate analysis (respectively, odds ratio [OR], 3.81 [95% confidence interval (CI), 1.16-12.5; P =. 02] and OR, 3.1 [95% CI, 0.7-13.7; P =. 01]). Body mass index, age, American Society of Anesthesiologists score ≥3, and pathological stage were not related to CCS ≥3. Conclusion: RC appears feasible in elderly patients with an sFI <3. In cases of sFI ≥3, this choice should be carefully valued, discussed, and possibly avoided because of a higher risk of complications.
KW - Bladder cancer
KW - Elderly
KW - Fraily
KW - Radical cystectomy
KW - Ureterocutaneostomy
UR - http://www.scopus.com/inward/record.url?scp=85070191345&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070191345&partnerID=8YFLogxK
U2 - 10.1016/j.clgc.2019.07.002
DO - 10.1016/j.clgc.2019.07.002
M3 - Article
C2 - 31402279
AN - SCOPUS:85070191345
VL - 17
SP - 402
EP - 407
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
SN - 1558-7673
IS - 5
ER -