Frail patients have higher mortality after radical cystectomy, finds study
Netherlands: Frailty is associated with a higher risk of postoperative adverse outcomes including death in patients undergoing radical cystectomy (RC), suggests a recent study in the journal BJU International.
Peter G. Noordzij, St. Antonius Hospital, Nieuwegein, The Netherlands, and colleagues aimed to determine the value of preoperative frailty screening in predicting postoperative severe complications and 1‐year mortality in patients undergoing radical cystectomy (RC).
For the purpose, the researchers conducted a prospective cohort single-center study in patients who underwent RC from September 2016 to December 2017. Preoperative frailty screening was used to guide shared decision‐making during multidisciplinary team meetings. The screening comprised of validated tools for assessing mental, physical, and social frailty. Patients having two or more frailty characteristics were considered as fragile.
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 length of stay, readmission within 30 days, any complication, and all-cause mortality.
The association and predictive value of preoperative frailty screening was described using logistic regression analysis and the concordance statistic (c‐statistic).
Key findings of the study include:
- Out of total 63 included; 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; 22 patients].
- Compared to the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index, frailty showed the best model performance (Nagelkerke R20.20) and discriminative ability(c‐statistic 0.72) for the primary endpoint.
- After adding frailty to the conventional ASA risk score, the c‐statistic improved by 11%.
- Overall survival was significantly worse in frail patients (23.2 months) vs non‐frail patients (32.9 months).
"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," concluded the authors.
The study, "Preoperative frailty and outcome in patients undergoing radical cystectomy," is published in the journal BJU International.