Radical cystectomy in patients aged < 80 years versus ≥ 80 years: analysis of preoperative geriatric assessment scores in predicting postoperative morbidity and mortality - Report - MDSpire
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Radical cystectomy in patients aged < 80 years versus ≥ 80 years: analysis of preoperative geriatric assessment scores in predicting postoperative morbidity and mortality
Preoperative Geriatric Assessment Scores Predict Postoperative Outcomes After Radical Cystectomy
Overview
This study compared common geriatric assessment scores (GAS) in predicting severe postoperative complications and mortality following radical cystectomy (RC) in patients under 80 versus those 80 and older. Patients aged ≥80 had significantly higher rates of severe complications (Clavien-Dindo ≥ IIIb) and 30- and 90-day mortality. The Preoperative Score to Predict Postoperative Mortality (POSPOM) and ASA classification were notably higher in the older cohort and correlated with worse outcomes.
Background
Radical cystectomy is the standard treatment for high-risk non-muscle-invasive and muscle-invasive bladder cancer but is associated with high perioperative morbidity and mortality, especially in elderly patients. With an aging population, more octogenarians undergo RC, yet chronological age alone is insufficient to guide treatment decisions. The European Association of Urology recommends using standardized geriatric assessments to better predict postoperative risks, but evidence on which scores best predict complications in elderly patients remains limited. This study addresses this gap by evaluating multiple GAS in patients undergoing RC, focusing on those aged 80 and above.
Data Highlights
Parameter
<80 years
≥80 years
p-value
Patients (n)
357
67
Median Age (years)
~70
≥80
Positive Resection Margin (R+)
9.48%
20.69%
0.046
POSPOM Score ≥ 28
0%
28.4%
<0.001
ASA Classification ≥ 3
58%
72.3%
Severe Complications (CDC ≥ IIIb)
27.7%
41.1%
30-day Mortality
1.7%
16.4%
90-day Mortality
4.8%
26.9%
Key Findings
Patients aged ≥80 years undergoing RC had significantly higher rates of severe postoperative complications (41.1% vs. 27.7%) compared to younger patients.
30-day and 90-day mortality rates were markedly elevated in the ≥80 years group (16.4% and 26.9%, respectively) versus younger patients.
The POSPOM score ≥28 and ASA classification ≥3 were significantly more frequent in the older cohort, correlating with worse postoperative outcomes.
Positive surgical margin rates were higher in patients ≥80 years (20.69% vs. 9.48%), potentially impacting prognosis.
Chronological age alone is insufficient to predict postoperative risk; comprehensive geriatric assessments improve risk stratification.
Clinical Implications
Incorporating validated geriatric assessment scores such as POSPOM and ASA classification into preoperative evaluation can enhance risk prediction for elderly patients considered for radical cystectomy. This approach supports individualized treatment decisions beyond chronological age, potentially improving perioperative management and patient counseling. Awareness of higher complication and mortality risks in octogenarians should prompt multidisciplinary optimization and consideration of alternative therapies when appropriate.
Conclusion
Geriatric assessment scores, particularly POSPOM and ASA classification, effectively predict severe postoperative complications and mortality in patients aged 80 and older undergoing radical cystectomy. These tools provide valuable guidance for clinical decision-making in this high-risk population.
References
EAU Guidelines 2022 -- Muscle-invasive and metastatic bladder cancer
Shabsigh et al. 2009 -- Defining early morbidity of radical cystectomy
Novotny et al. 2021 -- Impact of ERAS on radical cystectomy outcomes
Charlson et al. 1987 -- Charlson Comorbidity Index
Suskind et al. 2016 -- Frailty and radical cystectomy outcomes
by Gregor Duwe, Isabel Wagner, Katarzyna E. Banasiewicz, Lisa Johanna Frey, Nikita Dhruva Fischer, Johann Bierlein, Niklas Rölz, Maximilian Haack, Rene Mager, Christopher C. M. Neumann, Katharina Boehm, Peter Sparwasser, Igor Tsaur, Mohamed M. Kamal, Axel Haferkamp, Maximilian Peter Brandt, Thomas Höfner
