517 INITIAL EXPERIENCE ASSESSING PRE-OPERATIVE FRAILTY WITH PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR UROTHELIAL CANCER

Abstract

INTRODUCTION AND OBJECTIVES: Radical cystectomy for the treatment of bladder cancer is associated with significant postoperative morbidity and mortality, yet pre-operative risk stratification is relatively subjective. The decision to operate or not operate on a patient relies on very little objective/quantifiable data. Recently, the concept of frailty as a surgical risk assessment tool to predict postoperative outcomes has been introduced and is beginning to be examined clinically. In this initial study, we prospectively evaluated bladder cancer patients’ pre-operative frailty and attempted to correlate these presurgical measures with post-operative outcomes. METHODS: Patients undergoing radical cystectomy were voluntarily enrolled in this study after IRB approval was obtained. Preoperative frailty data was collected on the following five domains: shrinking, weakness, exhaustion, low physical activity, and walking speed. Patients were classified as either non-frail, intermediately frail, or frail, according to previously published objective standards. 30-day postoperative outcomes were recorded. RESULTS: During our initial 4-month study period, we collected data on 23 patients undergoing radical cystectomy. On average, data collection required only 4-6 minutes. Of this small cohort, 17 (73.9%) patients were white, and13 (56.5%) patients were males. Mean age was 65.83 years (range 43-84). Based on the five frailty domains, there were 12 (52.2%) non-frail, 10 (43.5%) intermediately frail, and 1 (4.3%) frail patients, respectively. Overall, there were 17 total complications: 12 (70.6%) Grade I/II, 3 (17.7%) Grade IIIa, 1 (5.9%) Grade IIIb, and 1 (5.9%) Grade V. There was a statistically significant relationship between increasing frailty and decreasing serum albumin (p 0.04). However, there was not a statistically significant association between increasing frailty and patients’ post-operative length of stay (p 0.2) and incidence of post-operative complications (p 0.4). CONCLUSIONS: Our initial experience with assessing preoperative frailty in patients undergoing radical cystectomy demonstrates that is easy and efficient to do in a busy clinical setting. Although our initial data does not show a correlation with post-operative outcomes, this is most likely due to our initial small sample size. Nevertheless, there is a statistically significant inverse relationship between frailty and serum albumin, suggesting that with a larger cohort frailty may predict post-operative outcomes. Further prospective evaluation is warranted and ongoing.