1762 HOSPITAL DISCHARGE STATUS OF ELDERLY PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive (III)1 Apr 20131762 HOSPITAL DISCHARGE STATUS OF ELDERLY PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR BLADDER CANCER Gareth Warren, Neil Shah, Heather Crossley, Stephen Dailey, Khaled Hafez, Chang He, Christopher Tallman, Jeffrey Montgomery, Alon Weizer, and Cheryl Lee Gareth WarrenGareth Warren Ann Arbor, MI More articles by this author , Neil ShahNeil Shah Ann Arbor, MI More articles by this author , Heather CrossleyHeather Crossley Ann Arbor, MI More articles by this author , Stephen DaileyStephen Dailey Ann Arbor, MI More articles by this author , Khaled HafezKhaled Hafez Ann Arbor, MI More articles by this author , Chang HeChang He Ann Arbor, MI More articles by this author , Christopher TallmanChristopher Tallman Ann Arbor, MI More articles by this author , Jeffrey MontgomeryJeffrey Montgomery Ann Arbor, MI More articles by this author , Alon WeizerAlon Weizer Ann Arbor, MI More articles by this author , and Cheryl LeeCheryl Lee Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2891AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment decision making process for elderly patients with high risk bladder cancer is complex. Although radical cystectomy (RC) provides excellent local control, elderly patients have a significant risk of complication after radical surgery that can threaten functional independence. Urologists need a greater understanding of factors that impact living status after RC. This study examines pre- and perioperative influences on discharge status of elder patients treated with RC. METHODS A total of 311 elderly patients (>75 years of age) underwent RC for bladder cancer at a single institution from 1995 to 2010. Living and discharge status was defined as: 1) home (with and without home health services) or 2) facility (subacute, rehabilitation, skilled nursing, or long-term care facilities). Discharge status also included a category termed, “death.” An assessment of hospital discharge status was performed. Using bivariate and multivariable analyses, we identified associations between clinicopathologic factors with declining living status after RC, hospital readmission, and 90-day mortality. RESULTS Mean patient age was 79 years. Of 311 patients, 1 died prior to discharge and 40 were discharged to a facility, representing a 13.2% decline in preoperative living status. On multivariable analysis, unmarried status (p=0.02), higher body mass index (BMI p=0.05), and longer length of hospital stay (p=0.01) were associated with decline in living status at discharge. Only BMI was associated with 90-day hospital readmission to our institution (p=0.02). A total of 12 (3.9%) patients died within 90 days of RC. On bivariate analysis, advanced age (p=0.04), female gender (p=0.02), and a decline in living status (p=0.04) were associated with 90-day mortality after RC. The small number of death events prevented multivariable analysis. CONCLUSIONS The large majority of elder patients maintain their living status after RC. A minority of patients, however, require support from an assisted living or rehabilitation facility, representing a decline in their preoperative living status. This may relate to lack of social support or complications that prolong hospital stay requiring resources unavailable in the home setting. This data is beneficial for patients in the decision making process to pursue RC and can aid clinicians in counseling patients and families about the potential loss of independent living after undergoing treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e724 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gareth Warren Ann Arbor, MI More articles by this author Neil Shah Ann Arbor, MI More articles by this author Heather Crossley Ann Arbor, MI More articles by this author Stephen Dailey Ann Arbor, MI More articles by this author Khaled Hafez Ann Arbor, MI More articles by this author Chang He Ann Arbor, MI More articles by this author Christopher Tallman Ann Arbor, MI More articles by this author Jeffrey Montgomery Ann Arbor, MI More articles by this author Alon Weizer Ann Arbor, MI More articles by this author Cheryl Lee Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...