Comprehensive characterization of the real-world perioperative morbidity of radical cystectomy in older adults

Abstract

Introduction: The perioperative morbidity of radical cystectomy (RC) is a critical factor for optimal decision-making in older adults with bladder cancer (BC). However, existing literature is dated and does not focus on older adults. We aimed to examine the real-world, perioperative morbidity of RC among older adults with BC.

Materials and methods: We identified 6041 patients aged 66-89 years diagnosed with T_anyN_anycM0 urothelial bladder cancer from 2000 to 2017 who underwent RC in SEER-Medicare. Rates of perioperative morbidity and healthy days at home (HDAH) were examined using Medicare claims. The associations between baseline characteristics and each outcome were evaluated using logistic regression and negative binomial regression.

Results: The perioperative morbidity of RC is substantial, with 3859 (64 %) patients experiencing a complication during hospitalization or one requiring care utilization post-discharge. A total of 1764 (29 %) patients required ER evaluation within 90 days of surgery, and 2637 (44 %) were readmitted to the hospital. The median number of HDAH was 78 (interquartile range 66-82). Adjusted multivariable analyses demonstrated that a higher Charlson Comorbidity Index (CCI) and higher census tract poverty level were associated with increased risk of 90-day inpatient readmission, while older age, Black race, higher CCI, and lower annual hospital RC volume were associated with increased risk of 90-day complications.

Discussion: The real-world perioperative morbidity of RC in older adults is substantial and even greater than reported in prior institutional studies, with 44 % of patients requiring hospital-based care within 90 days of surgery. These observations inform clinical counseling of older adults with bladder cancer.

Keywords: Bladder cancer; Medicare claims; Older adults; Postoperative complications; Radical cystectomy.