Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy: The Role of the Frailty Index

Cosimo De Nunzio, Antonio Cicione, Laura Izquierdo, Riccardo Lombardo, Giorgia Tema, Giuseppe Lotrecchiano, Andrea Minervini, Giuseppe Simone, Luca Cindolo, Carlo D'Orta, Tarek Ajami, Alessandro Antonelli, Marco Dellabella, Antonio Alcaraz, Andrea Tubaro

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)402-407
Number of pages6
JournalClinical Genitourinary Cancer
Volume17
Issue number5
DOIs
Publication statusPublished - Oct 1 2019

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Cystectomy
Length of Stay
Odds Ratio
Confidence Intervals
Urology
Chronic Obstructive Pulmonary Disease
Primary Health Care
Diabetes Mellitus
Body Mass Index
Multivariate Analysis
Heart Failure
Hypertension

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 journalArticle

De Nunzio, C, Cicione, A, Izquierdo, L, Lombardo, R, Tema, G, Lotrecchiano, G, Minervini, A, Simone, G, Cindolo, L, D'Orta, C, Ajami, T, Antonelli, A, Dellabella, M, Alcaraz, A & Tubaro, A 2019, 'Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy: The Role of the Frailty Index', Clinical Genitourinary Cancer, vol. 17, no. 5, pp. 402-407. https://doi.org/10.1016/j.clgc.2019.07.002
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. / Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy : The Role of the Frailty Index. In: Clinical Genitourinary Cancer. 2019 ; Vol. 17, No. 5. pp. 402-407.
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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.",
keywords = "Bladder cancer, Elderly, Fraily, Radical cystectomy, Ureterocutaneostomy",
author = "{De Nunzio}, Cosimo and Antonio Cicione and Laura Izquierdo and Riccardo Lombardo and Giorgia Tema and Giuseppe Lotrecchiano and Andrea Minervini and Giuseppe Simone and Luca Cindolo and Carlo D'Orta and Tarek Ajami and Alessandro Antonelli and Marco Dellabella and Antonio Alcaraz and Andrea Tubaro",
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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

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