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Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy
Michael Froehner1, Rainer Koch2, Matthias Hübler3
1Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany. Michael.Froehner@uniklinikum-dresden.de.
BMC Urology
|October 24, 2018
Summary
For elderly patients undergoing radical cystectomy, chronological age is a key predictor of 90-day mortality, but comorbidity is not. Risk extrapolations from younger patients to octogenarians should be cautious.
Area of Science:
- Urology
- Oncology
- Geriatric Medicine
Background:
- Radical cystectomy carries significant perioperative mortality risk, especially in elderly patients.
- Identifying predictors of mortality is crucial for optimizing care in this demographic.
- This study focuses on perioperative and long-term competing mortality in elderly patients undergoing radical cystectomy.
Purpose of the Study:
- To identify predictors of perioperative and long-term competing mortality in elderly patients undergoing radical cystectomy.
- To compare mortality predictors between younger and octogenarian patient groups.
- To inform risk stratification and clinical decision-making for radical cystectomy in older adults.
Main Methods:
- 1184 patients undergoing radical cystectomy were stratified into two groups: <80 years and ≥80 years.
- Multivariable and Cox proportional hazards models were employed for data analysis.
- Predictors of 90-day and long-term competing mortality were assessed.
Main Results:
- In patients <80 years, Charlson score and ASA physical status were independent predictors of 90-day mortality.
- In patients ≥80 years, only chronological age predicted 90-day mortality (OR 1.24 per year, p=0.0422).
- Neither age, Charlson score, nor ASA classification predicted long-term competing mortality in octogenarians.
Conclusions:
- Chronological age, not comorbidity, is a significant predictor of 90-day mortality in octogenarians undergoing radical cystectomy.
- Extrapolating mortality risks from younger patients to octogenarians is not advisable.
- Clinical decision-making for radical cystectomy in the elderly should consider age-specific prognostic factors.
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