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Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty.

Publication ,  Journal Article
Michel, J; Goel, AN; Golla, V; Lenis, AT; Johnson, DC; Chamie, K; Litwin, MS
Published in: Urology
November 2019

OBJECTIVE: To evaluate the impact of frailty on adverse perioperative outcomes in patients treated with radical cystectomy for bladder cancer. MATERIAL AND METHODS: We identified 9459 adults (age ≥18) in the Nationwide Readmission Database who underwent radical cystectomy in 2014 for bladder cancer. We defined patients' frailty status using Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator and compared in-hospital mortality, ICU-level complications, 30-day readmissions, nonhome discharge, length of hospitalization, and hospital-related costs between frail and nonfrail patients using χ2 tests. We used multivariate logistic regression to identify predictors of the primary outcomes of interest. RESULTS: Of 9459 patients undergoing radical cystectomy, 7.1% (n = 673) met criteria. Frail patients were more likely than nonfrail patients to have comorbid conditions (68.2% vs 59.7%; P= .005), in-hospital mortality (4.2% vs 1.5%; P= .04), ICU-level complications (52.9% vs 18.6%; P<.001), nonhome discharge (33.9% vs 11.6%; P <.001), longer length of stay (median 15 vs 7 days; P<.001), and higher median cost of the index admission ($39,665 vs $27,307). Frailty was the strongest independent predictor of ICU-level complications, nonhome discharge, increased length of stay, and hospital-related costs of any covariate. CONCLUSION: Frail patients receiving radical cystectomy were more likely than nonfrail patients to have adverse perioperative outcomes and higher odds of in-hospital mortality, ICU-level complications, nonhome discharge, increased length of stay, and hospital-related costs. Preoperative consideration of frailty may be useful in clinical guidance and shared decision-making.

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Published In

Urology

DOI

EISSN

1527-9995

Publication Date

November 2019

Volume

133

Start / End Page

25 / 33

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Bladder Neoplasms
  • Treatment Outcome
  • Time Factors
  • Retrospective Studies
  • Prognosis
  • Postoperative Complications
  • Male
  • Humans
  • Frailty
 

Citation

APA
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ICMJE
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Michel, J., Goel, A. N., Golla, V., Lenis, A. T., Johnson, D. C., Chamie, K., & Litwin, M. S. (2019). Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty. Urology, 133, 25–33. https://doi.org/10.1016/j.urology.2019.04.057
Michel, Joaquin, Alexander N. Goel, Vishnukamal Golla, Andrew T. Lenis, David C. Johnson, Karim Chamie, and Mark S. Litwin. “Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty.Urology 133 (November 2019): 25–33. https://doi.org/10.1016/j.urology.2019.04.057.
Michel J, Goel AN, Golla V, Lenis AT, Johnson DC, Chamie K, et al. Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty. Urology. 2019 Nov;133:25–33.
Michel, Joaquin, et al. “Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty.Urology, vol. 133, Nov. 2019, pp. 25–33. Pubmed, doi:10.1016/j.urology.2019.04.057.
Michel J, Goel AN, Golla V, Lenis AT, Johnson DC, Chamie K, Litwin MS. Predicting Short-term Outcomes After Radical Cystectomy Based on Frailty. Urology. 2019 Nov;133:25–33.
Journal cover image

Published In

Urology

DOI

EISSN

1527-9995

Publication Date

November 2019

Volume

133

Start / End Page

25 / 33

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Bladder Neoplasms
  • Treatment Outcome
  • Time Factors
  • Retrospective Studies
  • Prognosis
  • Postoperative Complications
  • Male
  • Humans
  • Frailty