Resident Physician University of Wisconsin School of Medicine and Public Health
Introduction: Previous literature has revealed that older patients with muscle invasive bladder cancer are less likely to undergo definitive treatment including cystectomy. As cystectomy is a potentially morbid operation, there are concerns that older patients may have worse outcomes. This study evaluated peri-operative outcomes of patients aged greater than 80 following cystectomy. Methods: A retrospective database was created, consisting of 370 consecutive patients who underwent cystectomy with urinary diversion from 2015 to 2022 by a single surgeon. Relationships between age and clinical parameters were assessed using T-tests, Chi-squared tests, and multivariable analysis. Results: Of the 370 patients, 42 (11%) were 80 years or older at the time of cystectomy. Baseline characteristics between the two groups are shown in Table 1. Older patients were more likely to undergo incontinent diversions (100% vs. 86%, p=0.009), have shorter OR times (275 min vs. 380 min, p<0.001), and undergo robotic approach less frequently (33% vs. 45%, p=0.2). No differences in mean Charlson Comorbidity Index (CCI) were noted between the two groups (0.98 vs. 1.18, p=0.9). There were no differences in median length of stay (LOS) (7 days vs. 7 days, p=0.7), 30-day readmission rate (31% vs. 32%, p>0.9), or rate of Clavien-Dindo = III complication within 30 days (12% vs. 10%, p=0.8) between the two groups. When controlling for surgical approach, diversion type, and CCI, age greater than 80 was not associated with LOS, risk of 30-day readmission, or risk of Clavien-Dindo = III complication within 30 days (Figure 1). Conclusions: Age greater than 80 was not associated with worse peri-operative outcomes following cystectomy. Patient selection is critical, as our cohort of patients above 80 had similar CCI compared to younger patients. These results suggest that in a well-selected patient, age alone should not be a contraindication for cystectomy. SOURCE OF Funding: N/A
