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

C. De Nunzio; A. Cicione; L. Izquierdo; R. Lombardo; G. Tema; G. Lotrecchiano; A. Minervini; G. Simone; L. Cindolo; C. D'Orta; T. Ajami; A. Antonelli; M. Dellabella; A. Alcaraz; A. Tubaro

doi:10.1016/j.clgc.2019.07.002

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

C. De Nunzio, A. Cicione, L. Izquierdo, R. Lombardo, G. Tema, G. Lotrecchiano, A. Minervini, G. Simone, L. Cindolo, C. D'Orta, T. Ajami, A. Antonelli, M. Dellabella, A. Alcaraz, A. Tubaro

Istituto Regina Elena

Research output: Contribution to journal › Article › peer-review

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 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, this choice should be carefully valued, discussed, and possibly avoided because of a higher risk of complications.

Original language	Italian
Pages (from-to)	402-407
Number of pages	6
Journal	Clinical Genitourinary Cancer
Volume	17
Issue number	5
DOIs	https://doi.org/10.1016/j.clgc.2019.07.002
Publication status	Published - 2019

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10.1016/j.clgc.2019.07.002

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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, 17(5), 402-407. https://doi.org/10.1016/j.clgc.2019.07.002

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

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

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 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, 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}, C. and A. Cicione and L. Izquierdo and R. Lombardo and G. Tema and G. Lotrecchiano and A. Minervini and G. Simone and L. Cindolo and C. D'Orta and T. Ajami and A. Antonelli and M. Dellabella and A. Alcaraz and A. Tubaro",

note = "LR: 20191013; CI: Copyright (c) 2019; JID: 101260955; OTO: NOTNLM; 2019/04/23 00:00 [received]; 2019/07/13 00:00 [revised]; 2019/07/15 00:00 [accepted]; 2019/08/14 06:00 [pubmed]; 2019/08/14 06:00 [medline]; 2019/08/13 06:00 [entrez]; ppublish M1 - Journal Article",

year = "2019",

doi = "10.1016/j.clgc.2019.07.002",

language = "Italian",

volume = "17",

pages = "402--407",

journal = "Clinical Genitourinary Cancer",

issn = "1558-7673",

publisher = "Elsevier Inc.",

number = "5",

}

TY - JOUR

T1 - Multicenter Analysis of Postoperative Complications in Octogenarians After Radical Cystectomy and Ureterocutaneostomy: The Role of the Frailty Index

AU - De Nunzio, C.

AU - Cicione, A.

AU - Izquierdo, L.

AU - Lombardo, R.

AU - Tema, G.

AU - Lotrecchiano, G.

AU - Minervini, A.

AU - Simone, G.

AU - Cindolo, L.

AU - D'Orta, C.

AU - Ajami, T.

AU - Antonelli, A.

AU - Dellabella, M.

AU - Alcaraz, A.

AU - Tubaro, A.

N1 - LR: 20191013; CI: Copyright (c) 2019; JID: 101260955; OTO: NOTNLM; 2019/04/23 00:00 [received]; 2019/07/13 00:00 [revised]; 2019/07/15 00:00 [accepted]; 2019/08/14 06:00 [pubmed]; 2019/08/14 06:00 [medline]; 2019/08/13 06:00 [entrez]; ppublish M1 - Journal Article

PY - 2019

Y1 - 2019

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 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, 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 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, 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

U2 - 10.1016/j.clgc.2019.07.002

DO - 10.1016/j.clgc.2019.07.002

M3 - Articolo

VL - 17

SP - 402

EP - 407

JO - Clinical Genitourinary Cancer

JF - Clinical Genitourinary Cancer

SN - 1558-7673

IS - 5

ER -