Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;205(2):400-406.
doi: 10.1097/JU.0000000000001360. Epub 2020 Sep 8.

Electronic Rapid Fitness Assessment Identifies Factors Associated with Adverse Early Postoperative Outcomes following Radical Cystectomy

Gregory T Chesnut  1 , Amy L Tin  2 , Daniel D Sjoberg  2 , Brian Jang  3 , Nicole Benfante  1 , Saman Sarraf  4 , Harry Herr  1 , S Machele Donat  1 , Guido Dalbagni  1 , Bernard Bochner  1 , Armin Shahrokni  4 , Alvin C Goh  1
Affiliations

Electronic Rapid Fitness Assessment Identifies Factors Associated with Adverse Early Postoperative Outcomes following Radical Cystectomy

Gregory T Chesnut et al. J Urol. 2021 Feb.

Abstract

Purpose: Frailty is associated with adverse outcomes following radical cystectomy. Prospective tools to identify factors affecting outcomes are needed. We describe a novel electronic rapid fitness assessment to evaluate geriatric patients undergoing radical cystectomy.

Materials and methods: Before undergoing radical cystectomy between February 2015 and February 2018, 80 patients older than age 75 years completed the electronic rapid fitness assessment and were perioperatively comanaged by the Geriatrics Service. Physical function and cognitive function over 12 domains were evaluated and an accumulated geriatric deficit score was compiled. Hospital length of stay, discharge disposition, unplanned intensive care unit admissions, urgent care visits, readmissions, complications and deaths were assessed.

Results: A total of 65 patients who underwent radical cystectomy for bladder cancer without concomitant procedures completed the assessment. Median age was 80 (77, 84) years and 52 (80%) were male. A higher proportion of patients with intensive care unit admission, urgent care visit and major complications had impairments identified within electronic rapid fitness assessment domains, including Timed Up and Go. Readmission rates were similar between patients with or without deficits identified. Higher accumulated geriatric deficit score was significantly associated with intensive care unit admission (p=0.035), death within 90 days (p=0.037) and discharge to other than home (p=0.0002).

Conclusions: We demonstrated the feasibility of assessing fitness in patients older than 75 years undergoing radical cystectomy using a novel electronic fitness tool. Physical limitations and overall impairment corresponded to higher intensive care unit admission rates and adverse postoperative outcomes. Larger studies in less resourced environments are required to validate these findings.

Keywords: aged; cystectomy; frailty.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Prevalence of preoperative impairments (and 95% C.I) captured on the eRFA.
Abbreviations: ADL, activities of daily living; iADL Lawton instrumental activities of daily living; KPS, Karnofsky Performance Scale; TUG, Timed Up and Go
See this image and copyright information in PMC

Comment in

References

    1. Scosyrev E, Noyes K, Feng C et al. : Sex and racial differences in bladder cancer presentation and mortality in the US. Cancer 2009; 115: 68. - PubMed
    1. Skinner EC: Treatment of Muscle-Invasive Bladder Cancer in Older Patients. Am Soc Clin Oncol Educ Book 2016; 35: e228. - PubMed
    1. Gray PJ, Fedewa SA, Shipley WU et al. : Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. Eur Urol 2013; 63: 823. - PubMed
    1. Shabsigh A, Korets R, Vora KC et al. : Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009; 55: 164. - PubMed
    1. Donat SM, Siegrist T, Cronin A et al. : Radical cystectomy in octogenarians--does morbidity outweigh the potential survival benefits? J Urol 2010; 183: 2171. - PubMed

Publication types