ACS 2019: Peri-Operative Outcomes and Discharge Destinations of Octogenarians Undergoing Radical Cystectomy: An Analysis of the NSQIP Database

San Francisco, California ( Dr. Hayden M. Hill presented work regarding radical cystectomy in the elderly and corresponding outcomes. Due to an aging general population, patients older than 80 years of age with muscle-invasive bladder cancer (MIBC) will increasingly undergo a radical cystectomy (RC). Discharge destination for elderly patients has been shown to be predictive of 90-day mortality.  Using a large administrative database, the objective of this study was to compare differences in discharge destination and peri-operative outcomes of octogenarians and younger patients undergoing RC. Using the National Surgical Quality Improvement Program database, they identified all patients with bladder cancer undergoing RC from 2011-2016. Patients were stratified by age into two cohorts <80 and ≥80 years old. Peri-operative outcomes and discharge destination between the two groups were compared.

A total of 5,628 patients underwent RC during the study period, 4987 (88.6%) patients <80 and 641 (11.4%) patients ≥80 years old. Comparative rates of discharge destination in patients <80 and ≥80 years old to home was 4398 patients (88.2%) v. 426 patients (66.5%) and to not home was 589 (11.8%) v. 215 (33.5%) (p≤0.01). In comparing the two groups, patients older than 80 years were more likely to have a minor complication (41.8% v. 36.0%, p=0.01), and die within 30 days of surgery (4.4% v. 1.4%, p<0.01).

In summary, octogenarians undergoing RC were found to have significantly increased rates of adverse peri-operative outcomes as well as a significantly higher rate of discharge to a facility. This data will possibly help to risk stratify surgery for patients older than the age of 80 years with MIBC.

Presented by: Hayden M. Hill, MD, Ochsner Clinic, Jefferson, Lousiana 

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons Clinical Congress October 27-31, 2019  - San Francisco, CA