Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy

Meera R. Chappidi, Max Kates, Hiten D. Patel, Jeffrey J. Tosoian, Deborah R. Kaye, Nikolai A. Sopko, Danny Lascano, Jen-Jane Liu, James McKiernan, Trinity J. Bivalacqua

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Abstract

Objective: To investigate the modified frailty index (mFI) as a preoperative predictor of postoperative complications following radical cystectomy (RC) in patients with bladder cancer. Materials and methods: Patients undergoing RC were identified from the National Surgical Quality Improvement Program participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to the National Surgical Quality Improvement Program comorbidities and activities of daily livings. The mFI groups were determined by the number of risk factors per patient (0, 1, 2, and≥3). Univariable and multivariable regression were performed to determine predictors of Clavien 4 and 5 complications, and a sensitivity analysis was performed to determine the mFI value that would be a significant predictor of Clavien 4 and 5 complications. Results: Of the 2,679 cystectomy patients identified, 843 (31%) of patients had an mFI of 0, 1176 (44%) had an mFI of 1, 555 (21%) had an mFI of 2, and 105 (4%) had an mFI≥3. Overall, 1585 (59%) of patients experienced a Clavien complication. When stratified at a cutoff of mFI≥2, the overall complication rate was not different (61.7% vs. 58.3%, P = 0.1), but the mFI2 or greater group had a significantly higher rate of Clavien grade 4 or 5 complications (14.6% vs. 8.3%, P80 years (odds ratio [OR] = 1.58 [1.11-2.27]), mFI2 (OR = 1.84 [1.28-2.64]), and mFI3 (OR = 2.58 [1.47-4.55]). Conclusions: Among patients undergoing RC, the mFI can identify those patients at greatest risk for severe complications and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, preoperative risk stratification is crucial to inform decision-making about surgical candidacy.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jul 26 2015
Externally publishedYes

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Keywords

  • Bladder cancer
  • Frailty
  • Perioperative outcomes
  • Radical cystectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Chappidi, M. R., Kates, M., Patel, H. D., Tosoian, J. J., Kaye, D. R., Sopko, N. A., Lascano, D., Liu, J-J., McKiernan, J., & Bivalacqua, T. J. (Accepted/In press). Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy. Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2015.12.010