A study investigating discharge destination and perioperative complications after radical cystectomy provides useful data for risk stratification and preoperative counseling of patients 80 years of age and older, said Hayden M. Hill, MD, who presented the research at the American College of Surgeons Clinical Congress in San Francisco.
The study was done using the ACS National Surgical Quality Improvement Program (NSQIP) database and identified 5,628 patients who underwent radical cystectomy from 2011 through 2016. Of the total population, 11.4% were ≥80 years of age. Compared with their younger population, the 80+ year-old group had a significantly longer hospital stay (median, 8 vs. 7 days) along with significantly higher rates of discharge to a facility (33.5% vs. 11.8%) and adverse perioperative outcomes.
“As the number of elderly patients with muscle-invasive bladder cancer will likely increase, we were interested in investigating their perioperative outcomes and discharge destination after radical cystectomy based on data from a previous study revealing that discharge to a skilled nursing facility after this operation was associated with increased 90-day mortality,” said Dr. Hill, urology resident, Ochsner Clinic, Jefferson, LA. “The NSQIP database only includes 30-day follow-up, but we believe that the increased rate of discharge to a facility we found for older patients likely equates to further adverse outcomes that may not be well captured by other studies.
“Our findings can help clinicians have an informed risk-benefit conversation with elderly patients and their families. Many older patients are good candidates for radical cystectomy, and our message is in no way meant to advocate against performing curative treatment in older patients with muscle-invasive bladder cancer,” added Dr. Hill, working with Daniel J. Canter, MD, and Kathleen Lata Arias, MPH.
Within both study age groups, the majority of patients were male (~82.5%) and Caucasian (~94%). A significantly higher percentage of octogenarians compared to patients age <80 years had an ileal conduit (93.9% vs. 77.2%).