Is the Barthel index a valid tool for patient selection before urological surgery? A systematic review

The Barthel Index (BI) measures the level of patient independence in activities of daily living. This review aims to summarize current evidence on the use of the BI in urology, highlighting its potential as a tool for assessing patients prior to surgery.

A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted for studies evaluating the BI in patients undergoing urologic surgery, following Systematic Review and Meta-analyses (PRISMA) guidelines. The BI was investigated both as a descriptor of baseline or postoperative health status and a prognostic indicator. A qualitative data synthesis was provided.

Overall, nine studies were included (three retrospective, six prospective). Surgical contexts included radical cystectomy (RC) in three studies, kidney transplantation in two, trans-urethral resection/vaporization of the prostate (TURP/TUVRP) in two, with the remainder including several different urological procedures for both oncological and non-oncological diseases. Evidence suggested that the BI reliably reflects functional status pre- and post-operatively, independently predicts major postoperative complications, prolonged hospital stay, higher healthcare costs, and poorer oncologic outcomes in RC patients. Additionally, the BI was associated with postoperative delirium in patients undergoing TURP and predicted the risk of deep vein thrombosis in patients undergoing major urological surgical procedures.

The BI is a valid tool for evaluating functional reserve in urologic patients. Its preoperative application can help identify patients at higher risk of adverse outcomes, thereby facilitating personalized treatment planning and optimizing surgical care.