The effect of age and comorbidities on early postoperative complications after radical cystectomy: A contemporary population-based analysis

Elio Mazzone, Felix Preisser, Sebastiano Nazzani, Zhe Tian, Emanuele Zaffuto, Andrea Gallina, Derya Tilki, Francesco Montorsi, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Background: Analyzing the relationship between perioperative outcomes and age in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC) in a continuous fashion may provide detailed information on the increased risk of complications in older patients, even after accounting for different comorbidity profiles. Given the limited data available in the literature, we tested these relationships within a large scale, population-based database. Materials and Methods: Within the NIS database (2003–2015), we identified patients who underwent RC for UCB. Multivariable logistic regression (MLoR) and Poisson regression (MPR) models were used after adjustment for clustering and stratification for comorbidity profiles. Results: Overall, 20,144 patients underwent RC with a median age of 70 years (interquartile range: 62–77). In MLoR models, continuously coded age represented an independent predictor of overall (odds ratio [OR]: 1.008, 95%-confidence interval [CI]: 1.005–1.012), cardiac (OR: 1.042, 95%-CI: 1.035–1.049), vascular (OR: 1.024, 95%-CI: 1.014–1.034), respiratory (OR: 1.016, 95%-CI 1.009–1.022), miscellaneous medical (OR: 1.013, 95%-CI: 1.009–1.017), infectious (OR: 1.012, 95%-CI 1.004–1.019), transfusions (OR: 1.011, 95%-CI 1.007–1.015) and bowel obstruction (OR: 1.009, 95%-CI 1.004–1.013) complications, and in-hospital mortality (OR: 1.057, 95%-CI 1.039–1.075). Conversely, patients age did not predict intraoperative (p = 0.7), genitourinary (p = 0.9), operative wound (p = 0.2) and miscellaneous surgical complications (p = 0.1). In MPR models, patients age predicted longer LOS (relative risk [RR]: 1.002, 95%-CI 1.001–1.003). Finally, a decreasing effect of age was observed in patients low vs high comorbidity burden for cardiac, respiratory and overall complications. Conclusions: Most of early postoperative RC complications are related to patients age, but its impact varies according to comorbidity profile. Further studies are needed to validate our findings that may be then considered for individual counselling and informed consent, as well as for health expenditure planning.

Original languageEnglish
Pages (from-to)623-631
Number of pages9
JournalJournal of Geriatric Oncology
Volume10
Issue number4
DOIs
Publication statusPublished - Jul 2019

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Keywords

  • Comorbidities
  • Complications
  • Older patients
  • Radical cystectomy
  • Urothelial carcinoma of the bladder

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

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