Login to Access Video or Poster Abstract: MP04-15
Sources of Funding: American Cancer Society Seed Grant.

Introduction

Perioperative morbidity is common amongst patients undergoing radical cystectomy. Frailty (decreased functional reserve) measurement has been proposed to identify at-risk patients, but there has been limited comparative prospective analysis of different frailty measures.

Methods

98 cystectomy patients at our institution from January 2015 to September 2016 were prospectively evaluated preoperatively, using the protocols for the four frailty indices: Duke Activity Status Index (DASI), Edmonton Frailty Index (EFI), Fried Frailty Index (FFI) and Schonberg Mortality Index (SMI) by a urology resident. Consensus Statement malnutrition assessment was performed by a dietitian. We examined the relationship between frailty, patient characteristics (age, neoadjuvant chemotherapy, malnutrition), and outcomes (length of stay 30-day readmission, 30-day Clavien grade > 2) were examined.

Results

Median DASI was 39.4 (IQR: 26.9, 58.2), median EFI was 3 (IQR: 2, 4.2), median FFI was 2 (IQR: 1, 3), and median SMI was 12 (IQR: 9.7, 15). The median age of cystectomy patients was 71 years (IQR: 62, 77). 66 of 98 (67.3%) patients underwent neoadjuvant chemotherapy while preoperative malnutrition was present in 32 of 98 (32.6%) patients. With respect to outcomes: median length of stay was 7 days (IQR: 5, 8), 30-day readmission rate was 25.8%, and the 30-day complication rate was 41.8%. The associations of variables with the four frailty indices are displayed in Table 1. Increased age was significantly associated with all four indices. Neoadjuvant chemotherapy was only associated with the FFI (p=0.04). The presence of malnutrition was associated with the EFI (p=0.02), FFI (p<0.01), and SMI (p=0.04). The SMI was only index related to postoperative outcomes, as increased SMI was associated with both 30-day complications (p=0.04) and 30-day readmission (p<0.01).

Conclusions

Different frailty indices appear to measure different aspects of functional status. In this prospective evaluation, frailty was associated with age, malnutrition, and complications to varying degrees. The SMI was the strongest predictor of readmission and postoperative complications in patients undergoing cystectomy. Evaluation of patients preoperatively can be used to better counsel patients about postoperative complication risk._x000D_

Funding

American Cancer Society Seed Grant.