Prospective evaluation of geriatric assessments as predictors of complications and functional outcome after major urologic tumor surgery in the older population.

Abstract

597 Background: Old patients undergoing major urologic tumor surgery are at severe risk of functional deterioration. In this study we prospectively performed a comprehensive geriatric assessment to identify potential risk predictors for early functional outcome. Methods: Since January 2016, 75 patients undergoing elective cystectomy, prostatectomy or nephrectomy at the age of 70 or older have been enrolled prospectively. A selection of geriatric assessment tools was applied before surgery. Follow up data including standardized peri- and postoperative parameters were obtained at discharge and at day 30 and 180 after surgery (DRKS-ID: DRKS00009825). Results: 14.7% had radical cystectomy, 33.3% had radical prostatectomy and 52.0% had kidney surgery due to malignant tumor. The average age was 75.7 (70-88) years. Within hospital stay, 20.3% had major complications (Clavien-Dindo > = 3) and 25% showed incomplete functional recovery at day 30 after surgery. The average reduction in activities of daily living (ADL) was -34.71. Major complications were significantly associated with impaired mobility (TUG, OR 7.350, p = 0.002), frailty (FrailScale, OR 5.007, p = 0.019) and ASA-Score (ASA, OR 4.400, p = 0.015). Incomplete functional recovery was strongly associated with preoperative impaired mobility (TUG, OR 11.524, p < 0.001) but correlation with ASA-Score (ASA, OR 3.288, p = 0.070) and comorbidities (CCI, OR 3.833, p = 0.106) missed statistical significance. No correlation of functional deterioration was found with age and functional status at admission. The combination of selected assessment tools showed good prediction of early functional recovery (ErlangerIndex, OR 4.400, p = 0.019). Conclusions: Major urologic tumor surgery has a high risk of severe complications and incomplete recovery in old patients. Fast and easy-to-do preoperative assessment tools may predict functional outcome more precisely than age or preoperative functional status alone. Clinical trial information: DRKS00009825.