Preoperative frailty and outcome in patients undergoing radical cystectomy

Abstract

Objective To determine the value of preoperative frailty screening in predicting postoperative severe complications and 1‐year mortality in patients undergoing radical cystectomy (RC). Patients and Methods Prospective cohort single‐centre study in patients undergoing RC from September 2016 to December 2017. Preoperative frailty screening was implemented as standard care and was used to guide shared decision‐making during multidisciplinary team meetings. Frailty screening consisted of validated tools to assess physical, mental and social frailty. Patients were considered frail when having two or more frailty characteristics. The primary endpoint was the composite of a severe complication (Clavien–Dindo Grade III–V) within 30 days and 1‐year all‐cause mortality. The secondary endpoints included any complication (Clavien–Dindo II–V), length of stay, readmission within 30 days, and all‐cause mortality. Logistic regression analysis and the concordance statistic (c‐statistic) were used to describe the association and predictive value of preoperative frailty screening. Results A total of 63 patients were included; 39 (61.9%) were considered frail. Preoperative frailty was associated with a seven‐fold increased risk of a severe complication or death 1 year after RC [adjusted odds ratio (OR) 7.36, 95% confidence interval (CI) 1.7–31.8; 22 patients]. Compared to the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index, frailty showed the best model performance (Nagelkerke R2 0.20) and discriminative ability(c‐statistic 0.72, P < 0.01) for the primary endpoint. After adding frailty to the conventional ASA risk score, the c‐statistic improved by 11% (P < 0.01). Overall survival was significantly worse in frail patients (23.2 months, 95% CI 18.7–30.1) vs non‐frail patients (32.9 months, 95% CI 30.0–35.9; P = 0.01). Conclusions Frail patients undergoing RC are at high risk of postoperative adverse outcomes including death. Preoperative frailty screening improves preoperative risk stratification and may be used to guide patient selection for RC.

The effect of body mass index on quality of life in modified single stoma cutaneous ureterostomy or ileal conduit after radical cystectomy

“…For this kind of elderly and obese patients, the decreased skeletal muscle content and frailty significantly diminished their capacity to tolerate RC and urinary diversion surgery and impacted perioperative outcomes and long‐term postoperative prognosis. Related studies had shown that frail patients have an increased rate of perioperative complications and an increased risk of death after surgery 31,32 . While effective weight management and lifestyle intervention can reduce the complications caused by obesity, improving the frailty of patients and their QoL 33 .…”

Risk factors for postoperative ileus after robot‐assisted radical cystectomy with intracorporeal urinary diversion

“…Previous studies showed that frailty was associated with the treatment modality selection, type of urinary diversion, and adverse postoperative outcomes. [22][23][24] In addition, frailty was associated with an increased odds of delayed GI function recovery or the rate of POI or anastomotic leakage in patients who underwent elective colorectal cancer resections. These findings suggest that there is an association between frailty and the delayed bowel function or POI.…”

The CUSUM curve combined with comprehensive complication index for assessing short‐term complications of radical cystectomy

“…Complications are mostly caused by surgical stress, particularly age and physical conditions, all of which have recently been found as predictors of higher complication rates. 17 , 24 , 25 We used the ACCI in our study to account for patients' characteristics. However, our findings revealed that age and ACCI scores were not prognostic indicators for severe complication rates, neither the CDC nor the CCI grading exhibited statistically significant differences.…”

“…Complications are mostly caused by surgical stress, particularly age and physical conditions, all of which have recently been found as predictors of higher complication rates 17,24,25 . We used the ACCI in our study to account for patients' characteristics.…”