Radical cystectomy in patients over 70 years of age: impact of comorbidity on perioperative morbidity and mortality

Abstract

Purpose: To analyze the impact of comorbidity on the perioperative complication rate after radical cystectomy in patients over 70 year of age.

Methods: Between April 1993 and August 2010, 830 radical cystectomies were performed at our institution. Of the 830 patients, 365 patients (44.0%) were ≥70-year-old (median age 74 year). This group of elderly patients was compared with a younger group of 465 patients (56.0% of the whole cohort) aged under 70 year (median 63 year).

Results: The group of elderly patients had a significantly higher prevalence of concomitant diseases e.g., hypertension (57.3% vs. 38.5%), coronary heart disease (27.1% vs. 14.8%) and diabetes (25.5% vs. 14.6%). Perioperative complications were significantly more frequent in the elderly group: 31.0% versus 21.5% overall complication rate, P = 0.002. Mortality rate was almost similar in both groups: 0.6% (elderly) versus 0.5% (younger). Within the elderly group, the overall complication rate was significantly higher in patients with an ASA score ≥3 (37.0%) than in patients with an ASA score ≤2 (25.0%) (P < 0.02). Multivariate logistic regression analysis was used to identify that chronic obstructive lung disease, ASA score and age were independent predictive factors for perioperative complications.

Conclusions: Elderly patients have a higher prevalence of concomitant systemic diseases. Some concomitant diseases can affect surgical outcome after radical cystectomy, particularly the frequency and character of perioperative complications. It is therefore of paramount importance to conduct a comorbidity assessment and preoperative conditioning of each patient, with a special focus on the patient's individual risk factors and age.