Impact of functional impairment and cognitive status on perioperative outcomes and costs after radical cystectomy: The role of Barthel Index

Abstract

Objectives To investigate the association between Barthel Index (BI), which measures level of patients independence during daily living activities (ADL), and perioperative outcomes in a large cohort of consecutive bladder cancer (BCa) patients, who underwent radical cystectomy (RC) at a tertiary referral center. Methods We retrospectively evaluated data from clinically nonmetastatic BCa patients treated with RC between 2015 and 2022. For each patient, BI was assessed preoperatively. According to BI score, patients were divided into three groups: ≤60 (total/severe dependency) vs. 65–90 (moderate dependency) vs. 95–100 (slight dependency/independency). Regression analyses tested the association between BI score and major postoperative complications (Clavien–Dindo >2), length of in‐hospital stay (LOHS), 90‐days readmission, and total costs. Results Overall, 288 patients were included. According to BI score, the patient cohort was distributed as follows: 4% (n = 11) BI ≤60 vs. 15% (n = 42) BI 65–90 vs. 81% (n = 235) BI 95–100. Patients with BI ≤60 had more frequent ureterocutaneostomy performed, shorter operative time, higher rates of postoperative complications, longer LOHS, higher rates of readmission, and were associated with higher total costs, compared to patients with BI 65–90 and 95–100. In multivariable regression models, BI ≤60 remained an independent predictor of increased risk of major postoperative complications (odds ratio: 6.62, p = 0.006), longer LOHS (rate ratio: 1.25, p < 0.001), and higher costs (β: 2.617, p = 0.038). Conclusions Total/severe dependency in ADL assessed by BI was associated with higher rates of major postoperative complications, longer hospitalization, and higher costs in BCa patients treated with RC. BI assessment should be considered during patients selection process and counseling before surgery.

Chronic kidney disease and Charlson comorbidity index predict complications after robot‐assisted radical cystectomy: A single‐center study in Japan

“…Fourth, we were unable to examine functional and cognitive assessments of the older adults in their activities of daily living within this study. It has been reported that the Barthel index is strongly correlated with perioperative outcomes 27 . However, the absence of such information in the collected data prevented us from investigating its impact.…”

“…It has been reported that the Barthel index is strongly correlated with perioperative outcomes. 27 However, the absence of such information in the collected data prevented us from investigating its impact. Finally, the sample size was small.…”

Editorial Comment on Impact of functional impairment and cognitive status on perioperative outcomes and costs after radical cystectomy: The role of Barthel Index

“…Therefore, multimodal scales are needed to attempt a more comprehensive definition of patient's health status. 1 Radical cystectomy (RC) is indeed a complex surgery associated with high rate of complications. 2 The clinical adoption of standardized comorbidity indexes provides a rational background for a personalized medicine.…”

“…As a result, surgeons will face up always more on elderly and frail patients. Therefore, multimodal scales are needed to attempt a more comprehensive definition of patient's health status 1 . Radical cystectomy (RC) is indeed a complex surgery associated with high rate of complications 2 .…”