Functional Status in Patients Requiring Nursing Home Stay After Radical Cystectomy

Murray, Katie S.; Prunty, Megan; Henderson, Alex A.; Haden, Tyler; Pokala, Naveen; Ge, Bin; Wakefield, Mark R.; Petroski, Gregory F.; Mehr, David R.; Kruse, Robin L.

doi:10.1016/j.urology.2018.07.030

Cited by 11 publications

(13 citation statements)

References 27 publications

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“…Although it was shown that poor preoperative exercise tolerance, limited functions, positive surgical margins and longer length of hospital stay were correlated with postoperative need for nursing home care, this evaluation needs to be supported by other studies [10,11]. Murray et al [2] stated that patients who were discharged from high volume centers performing radical cystectomy (more than eight per year) had lower postoperative need for nursing facilities. Moreover, patients with higher risk of 30-day mortality were shown to have need for nursing or rehabilitation facilities following discharge [5].…”

Section: Discussionmentioning

confidence: 97%

“…On the other hand, eating is the well preserved and last decreased function. According to Murrey et al [2], there were not differences in terms of activities of daily living between patients living in nurse home prior to cystectomy and patients not living. But a great impairment was observed in the ability of performing activities of daily living in postoperatively.…”

Section: Discussionmentioning

confidence: 98%

“…Most of the previous studies in literature have evaluated morbidity and mortality related to radical cystectomy [2]. Patients' functional status have been investigated with several indexes.…”

Section: Discussionmentioning

confidence: 99%

“…The gold standard treatment option for T2-T4aN0M0 (muscle-invasive) bladder cancer is radical cystectomy with bilateral pelvic lymph node dissection and urinary diversion. But radical cystectomy can be another option for multiple, large non-muscle invasive tumors if complete transurethral resection is not possible [2].…”

Section: Introductionmentioning

confidence: 99%

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Does Uro-Oncology Nursing Education Decrease the need for Out of Home Care following Radical Cystectomy? An Observational Study

2019

JNH

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Objective: Our aim is to evaluate the effects of uro-oncology nursing education program on quality of life, general health status and the need for out of home care following radical cystectomy Materials and methods: The datas of 60 patients who were underwent radical cystectomy due to bladder cancer and followed up between January 2013 and December 2017 were retrospectively evaluated. We have prepared a special education program for our nurses about uro-oncological surgeries and the follow-up process since January 2015. Patients were divided into two groups: 28 patients before nursing education and 32 patients after nursing education. We compared the patient satisfaction, the quality of health care given to the patients by nurses and the requirement of need for out of home care following discharge in the periods before and after nursing education. Results: Although uro-oncology nursing education did not affect the rates of deterioration in activities of daily living, satisfaction rates of the patients and their relatives were observed as significantly higher in the period of following the Uro-Oncology Nursing Education Program (90.6% vs. 71.4%, p=0.04). The decline in anxiety/depression (28.1% vs. 53.6%, p=0.04) in this period was attributed to the nursing education. The patients and their relatives felt themselves better and in confidence about coping with undesirable problems related to cystectomy. Parallel to this situation, the need for out of home care such as skilled nursing or rehabilitation facilities were seen significantly lower following uro-oncology nursing education (28.1% vs. 64.3%, p=0.005). Conclusion: The standardization of uro-oncology nursing care practices will provide better relief of symptoms related major uro-oncologic surgeries such as radical cystectomy and increase health related quality of life. It may contribute to declines of out of home care requirement.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Uro-Oncology Nursing Education Decrease the need for Out of Home Care following Radical Cystectomy? An Observational Study

2019

JNH

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“…This difference might reflect a major, prolonged loss of autonomy after RC in our geriatric population. Indeed, Murray et al showed that patients who needed a care facility after RC had impaired ADL [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Complications and Discharge after Radical Cystectomy for Older Patients with Muscle-Invasive Bladder Cancer: The ELCAPA-27 Cohort Study

Geiss

Sebaste

Valter

et al. 2021

Cancers

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Radical cystectomy is the standard of care for localized bladder cancer but is associated with high morbidity and mortality rates—especially among older patients with comorbidities. The association between geriatric assessment parameters on post-operative complications and discharge has not previously been investigated. The present analysis of the Elderly Cancer Patient (ELCAPA) prospective cohort included all patients aged ≥70 having undergone a geriatric assessment and then radical cystectomy for localized muscle-invasive bladder cancer between 2007 and 2018. The primary endpoint was the proportion of patients with one or more complications in the first 30 days after cystectomy. The secondary endpoints were the length of hospital stay (LOS), the 30-day mortality, and discharge rates. Sixty-two patients (median age: 81; range: 79–83.8) were included. The 30-day complication rate was 73%, and 49% of the patients had experienced a major complication, according to the Clavien-Dindo classification. The 30-day mortality rate was 4%. None of the geriatric, oncological, or laboratory parameters were significantly associated with the occurrence or severity of complications. The median (interquartile range) LOS was 18 days (15–23) overall and was longer in patients with complications (19 days vs. 15 days in those without complications; p = 0.013). Thirty days after cystectomy, 25 patients (53%) had been discharged to home and 22 (47%) were still in a rehabilitation unit. In a univariate analysis, a Geriatric-8 score ≤ 14, a loss of one point on the Activities of Daily Living Scale, anemia, at least one grade ≥ 3 comorbidity on the Cumulative Illness Rating Scale-Geriatric, and an inpatient geriatric assessment were associated with a risk of not being discharged to home. In older patients having undergone a geriatric assessment, radical cystectomy is associated with a high complication rate, a longer LOS, and functional decline at 30 days.

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Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

et al. 2022

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IMPORTANCENo data exist on time to recovery of patient-reported and performance-related measures of functional independence after radical cystectomy (open or robotic). OBJECTIVE To determine recovery of functional independence after radical cystectomy and whether robot-assisted radical cystectomy (RARC) is associated with any advantage over open procedures. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis from the RAZOR (Randomized Open vs Robotic Cystectomy) trial were used. RAZOR was a phase 3 multicenter noninferiority trial across 15 academic medical centers in the US from July 1, 2011, to November 18, 2014, with a median follow-up of 2 years. Participants included the per-protocol population (n = 302). Data were analyzed from February 1, 2017, to May 1, 2021. INTERVENTIONS Robot-assisted radical cystectomy or open radical cystectomy (ORC). MAIN OUTCOMES AND MEASURES Patient-reported (activities of daily living [ADL] and independent ADL [iADL]) and performance-related (hand grip strength [HGS] and Timed Up & Go walking test [TUGWT]) measures of independence were assessed. Patterns of postoperative recovery for the entire cohort and comparisons between RARC and ORC were performed. Exploratory analyses to assess measures of independence across diversion type and to determine whether baseline impairments were associated with 90-day complications or 1-year mortality were performed. FINDINGS Of the 302 patients included in the analysis (254 men [84.1%]; mean [SD] age at consent, 68.0 [9.7] years), 150 underwent RARC and 152 underwent ORC. Baseline characteristics were similar in both groups. For the entire cohort, ADL, iADL, and TUGWT recovered to baseline by 3 postoperative months, whereas HGS recovered by 6 months. There was no difference between RARC and ORC for ADL, iADL, TUGWT, or HGS scores at any time. Activities of daily living recovered 1 month after RARC (mean estimated score, 7.7 [95% CI, 7.3-8.0]) vs 3 months after ORC (mean estimated score, 7.5 [95% CI, 7.2-7.8]). Hand grip strength recovered by 3 months after RARC (mean estimated HGS, 29.0 [95% CI, 26.3-31.7] kg) vs 6 months after ORC (mean estimated HGS, 31.2 [95% CI,] kg). In the RARC group, 32 of 90 patients (35.6%) showed a recovery in HGS at 3 months vs 32 of 88 (36.4%) in the ORC group (P = .91), indicating a rejection of the primary study hypothesis for HGS. Independent ADL and TUGWT recovered in 3 months for both approaches. Hand grip strength showed earlier recovery in patients undergoing continent urinary diversion (mean HGS at 3 months, 31.3 [95% CI,] vs 33.9 [95% CI, 30.5-37.3] at baseline; P = .09) than (continued) Key Points Question Is robot-assisted radical cystectomy (RARC) associated with faster recovery of patient-reported and performance-related measures of independence when compared with open radical cystectomy (ORC)? Findings This secondary analysis of the RAZOR (Randomized Open vs Robotic Cystectomy) trial found that patients require 3 to 6 months to recover baseline levels of independence irrespective of su...

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Functional Status in Patients Requiring Nursing Home Stay After Radical Cystectomy

Abstract: ADLs, as measured by the MDS-ADL Long Form score, worsen after RC. This should be an important part of the risks and benefits conversation with patients, their families, and caregivers.

Cited by 11 publications

References 27 publications

Does Uro-Oncology Nursing Education Decrease the need for Out of Home Care following Radical Cystectomy? An Observational Study

Does Uro-Oncology Nursing Education Decrease the need for Out of Home Care following Radical Cystectomy? An Observational Study

Complications and Discharge after Radical Cystectomy for Older Patients with Muscle-Invasive Bladder Cancer: The ELCAPA-27 Cohort Study

Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

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