Frail patients undergoing radical cystectomy (RC) for bladder cancer are more likely than non-frail patients to experience adverse perioperative outcomes and increased likelihood of in-hospital mortality, according to a new study.

In a study of 9459 RC patients, Joaquin Michel, of David Geffen School of Medicine at UCLA, and colleagues found that significantly greater proportions of frail than non-frail patients had comorbid conditions (68.2% vs 59.7%), in-hospital mortality (4.2% vs 1.5%), intensive care unit (ICU)-level complications (52.9% vs 18.6%), and non-home discharge (33.9% vs 11.6%). Frail patients also had a significantly longer median hospital length of stay (15 vs 7 days) and higher median cost of index admission ($39,665 vs $27,307). Frailty was the strongest independent predictor of ICU-level complications, non-home discharge, increased length of stay, and hospital-related costs.

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“Frailty assessment during preoperative evaluation may be useful in risk stratification, clinical assessment, and shared decision-making about surgical candidacy,” the investigators concluded in Urology.

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Michel and his colleagues assessed frailty status using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Of the 9459 patients, 673 (7.1%) met frailty criteria. On multivariate analysis, frailty was associated with significant 2.3-, 4.7-, 2.0- and 1.8-fold increased odds of in-hospital mortality, ICU-level complications, non-home discharge, and 30-day readmission, respectively.


Michel J, Goel AN, Golla V, et al. Predicting short-term outcomes after radical cystectomy based on frailty. Urology. 2019; published online ahead of print.

DOI: 10.1016/j.urology.2019.04.057