Introduction: For patients with muscle invasive bladder cancer radical cystectomy remains the gold standard. There is significant risk associated with this procedure and we aim to evaluate patient characteristics that may predict outcomes following surgery. The modified frailty index (MFI) is used as a tool for predicting morbidity.
Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) public use files (PUF) between 2012 and 2018 were reviewed for cases of radical cystectomy, with 10,338 total observations. Morbidity was defined by the following 30-day complications: mortality, superficial incisional surgical site infection (SSI), deep incisional SSI, organ/space SSI, wound dehiscence, pneumonia, bleeding requiring transfusion, urinary tract infection (UTI), unplanned intubation, ventilator for more than 48 hours, sepsis, acute renal failure, progressive renal insufficiency, pulmonary embolism, deep vein thrombosis (DVT) or thrombophlebitis, cardiac arrest requiring CPR, myocardial infarction, and stroke with neurological deficit or cerebrovascular accident (CVA).
The modified frailty index score is defined on a scale of 1 to 5, with each patient receiving one point per each of their existing comorbidities: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension that requires medication, or a functional status that was not dependent.
Results: Variables found to have significant differences when compared to MFI scores include patient age, gender, race, BMI, ASA class, and smoking history. Post-operative variables with statistical significance in relation to MFI scores include LOS, surgical site infection, sepsis, pneumonia, unplanned intubations, need for transfusion, readmission, and returns to the operating room. Under multivariate analysis of morbidity by frailty score, adjusting for all significant patient characteristics and operation duration, significance was found for MFI >2, age >80, male sex, minority race, smoking history, disseminated cancer, and operation duration greater than 320 minutes.
Conclusions: We believe mFI score is an effective pre-operative tool for evaluating potential morbidity in patients with MIBC who are under consideration for radical cystectomy.
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