AUA 2017: The Prevalence and Impact of Preoperative Frailty: A Prospective Study of Patients Undergoing Cystectomy
A total of 103 patients undergoing radical cystectomy were identified and prospectively evaluated preoperatively using the Duke Activity Index, Edmonton Frailty Index, Fried Frailty Index and the Schonberg Mortality Index. The primary outcome was 30-day complication rate ≥ Clavien Grade III.
Median age was 71 years, majority male (85%), 33% malnourished and median BMI 28 kg/m2 with approximately 70% having received neoadjuvant chemotherapy. Median length of stay was 7 days with 25% and 41% of patients having 30-day readmission and complications, respectively. The Schonberg Mortality Index was the only index significantly associated with 30-day readmission and complications. However, the authors did not identify any preoperative variables associated with individual frailty using the Schonberg Mortality Index.
Limitations include limited numbers of patients, unknown number of patients excluded/did not complete the questionnaire, lack of pathologic information as well as description of the procedure performed. Moreover, there is lack of comparison and/or controlling for comorbidities using standardized indices such as Charlson and Elixhauser comorbidity indices. Interestingly, the Schonberg Mortality Index provides the most comprehensive comorbidity assessment which has 11 components consisting of age, gender, smoking, BMI, cancer, diabetes mellitus, COPD, hospitalizations in past year, self-health rating, ADLs and ability to walk a quarter mile. Given this was the only index associated with 30-day complication and readmission rate one questions how well this index measures these outcomes in comparison to other comorbidity indices and may likely improve the predictability of the Schonberg Mortality Index when used in combination.
Given concerns regarding underutilization and morbidity associated with radical cystectomy, there is a need for incorporation of cancer-specific and competing risks into patient counseling and guideline recommendations. We recently developed and validated a generalizable instrument using SEER-Medicare and Texas Cancer Registry Medicare-linked databases, respectively. This has been converted into an on-line tool (Radical Cystectomy Survival Calculator© (RCSC)), to provide a benefit-risk assessment for patients considering radical cystectomy.
Presented By: Conrad Tobert, University of Iowa
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA