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Radical cystectomy in patients aged < 80 years versus ≥ 80 years: analysis of preoperative geriatric assessment scores in predicting postoperative morbidity and mortality.
Duwe, Gregor; Wagner, Isabel; Banasiewicz, Katarzyna E; Frey, Lisa Johanna; Fischer, Nikita Dhruva; Bierlein, Johann; Rölz, Niklas; Haack, Maximilian; Mager, Rene; Neumann, Christopher C M; Boehm, Katharina; Sparwasser, Peter; Tsaur, Igor; Kamal, Mohamed M; Haferkamp, Axel; Brandt, Maximilian Peter; Höfner, Thomas.
Afiliación
  • Duwe G; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. gregor.duwe@unimedizin-mainz.de.
  • Wagner I; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Banasiewicz KE; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Frey LJ; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Fischer ND; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Bierlein J; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Rölz N; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Haack M; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Mager R; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Neumann CCM; Department of Hematology, Oncology, and Cancer Immunology (CCM), Charité - Universitaetsmedizin Berlin, 10117, Berlin, Germany.
  • Boehm K; Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, 01307, Dresden, Germany.
  • Sparwasser P; Department of Urology, Faculty of Medicine, University Hospital, Eberhard Karls University, 72076, Tübingen, Tuebingen, Germany.
  • Tsaur I; Department of Urology, Faculty of Medicine, University Hospital, Eberhard Karls University, 72076, Tübingen, Tuebingen, Germany.
  • Kamal MM; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Haferkamp A; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Brandt MP; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
  • Höfner T; Department of Urology and Pediatric Urology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
World J Urol ; 42(1): 552, 2024 Sep 30.
Article en En | MEDLINE | ID: mdl-39347804
ABSTRACT

PURPOSE:

Pre-operative assessment of surgical risk is essential for patient counselling in the elderly patient population. Our purpose was to compare validated geriatric assessment scores (GAS) in predicting postoperative morbidity and mortality in patients ≥ 80 years.

METHODS:

Overall, eight preoperative GAS were assessed for each patient who received RC from 2016 to 2021. Postoperative morbidity was recorded according to the Clavien-Dindo classification (CDC) of surgical complications. Binary logistic regression analyses were used to determine prediction of 30-d morbidity and 90-d mortality in patients ≥ 80 years.

RESULTS:

In total, 424 patients were analysed (77.4% male) with median age of 71 years (IQR 68.82;70.69), of which 67 (15.8%) were ≥ 80 years. Patients age ≥ 80 years showed more 30-d CDC grade ≥ IIIb (41.07% vs. 27.74% compared to < 80 years, p < .001) and worse 90-d mortality (26.87% vs. 4.76%, p < .001). In patients ≥ 80 years, morbidity was predicted by simplified Frailty Index (sFI)  ≥ 2 (OR 2.06, 95% CI 1.27-3.34, p = .004), Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2 (OR 2.78, 95% CI 1.18-6.54, p = .019) and severe Adult Comorbidity Evaluation (ACE)-27 score (OR 2.07, 95% CI 1.13-3.79, p = .019), while 90-d mortality was predicted by CDC grade ≥ IIIb (OR 22.91, 95% CI 8.74-60.09, p < .001) and ECOG ≥ 2 (OR 2.87, 95% CI 1.05-7.86, p = .04).

CONCLUSION:

Even in a high-volume center of RC, 90-d mortality is significantly higher in patients age ≥ 80. Our results suggest in patient age ≥ 80, sFI ≥ 2, ECOG performance status ≥ 2 and severe ACE-27 score as clinical cut-off value to evaluate alternative bladder-sparing concepts.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Neoplasias de la Vejiga Urinaria / Cistectomía / Evaluación Geriátrica Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: World J Urol Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Alemania

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Neoplasias de la Vejiga Urinaria / Cistectomía / Evaluación Geriátrica Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: World J Urol Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Alemania