Frailty Assessment May Benefit Patients Undergoing Radical Cystectomy

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Older patients should be routinely assessed prior to radical cystectomy to guide both preoperative and postoperative care.
Older patients should be routinely assessed prior to radical cystectomy to guide both preoperative and postoperative care.

Phenotypic frailty assessment can be performed in 5 minutes to 7 minutes by clinic staff and may be highly worth the trouble in patients preparing to undergo radical cystectomy (RC). A new study published in the journal Urologic Oncology suggested that a comprehensive frailty assessment may help predict which patients are at increased risk for 30-day and 90-day complications following RC.1

Madeleine L. Burg, MD candidate, Keck School of Medicine, University of Southern California(USC), Los Angeles, California, and colleagues preoperatively assessed 123 patients aged 65 years or older undergoing RC using Fried Frailty Criteria (FFC; grip strength, gait speed, exhaustion, physical activity, shrinking), Charlson Comorbidity Index, and the American Society of Anesthesiologists score. They also utilized the Katz Index of Independence in Activities of Daily Living, Karnofsky Performance Scale, Eastern Cooperative Oncology Group performance status, and Center for Epidemiological Studies Depression scale. 

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The median age in this cohort was 74 years and the findings showed that some deficits could be identified early and targeted preoperatively. The researchers found that 48% of the patients had at least one complication within 30 days and 58.5% had at least one complication within 90 days. The study showed an association with an increased risk for any 30-day complication through The Center for Epidemiological Studies Depression scale (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01−1.17, P = .027) and shrinking, defined as weight loss (OR 3.79, 95% CI 1.64−9.26, P = .0024).

Higher levels of physical activity were found to be protective (OR 0.84) for any 90-day complication.  Individuals who were deemed intermediately frail or frail were at a higher risk for high-grade 30-day (OR 4.87, 95% CI 0.69−1.00, P = .072) and 90-day complications (OR 3.01, 95% CI 1.05−9.37, P = .045). The authors concluded that older patients should be routinely assessed prior to RC to guide both preoperative and postoperative care.  

Reference

  1. Burg ML, Clifford TG, Bazargani ST, et al. Frailty as a predictor of complications after radical cystectomy: A prospective study of various preoperative assessments [published online November 15, 2018]. Urol Oncol. 2019;37(1):40-47.

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