Comorbid Illnesses Worsen Post-Cystectomy Outcomes

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Greater comorbid illness increases the likelihood of complications after radical cystectomy for bladder cancer among patients older than 70 years, according to German researchers.

In this patient age group, those with an American Society of Anesthesiologists (ASA) score of 3 or greater—indicating severe systemic diseases—had a significantly higher rate of perioperative complications than those with an ASA score of 2 or less—indicating mild systemic diseases (37% vs. 25%), investigators reported online in the World Journal of Urology.

An ASA score is a global score that assesses the physical status of patients before surgery. For the study, the researchers defined perioperative complications as any adverse event within 30 days of surgery.

“A careful consideration of individual comorbidity is important in both preparing the patient for surgery and during the whole perioperative management,” the authors concluded. “Improved attention to reasonable perioperative processes during radical cystectomy can result in better patient outcomes.”

Vladimir Novotny, MD, and colleagues at Technical University Dresden studied 830 patients who underwent radical cystectomy. Of these, 365 (44%) were aged 70 years and older (elderly) and 465 (56%) were younger than 70.

The elderly cohort had a significantly higher prevalence of concomitant diseases, such as hypertension (57.3% vs. 38.5%), coronary heart disease (27.1% vs. 14.8%), and diabetes (25.5% vs. 14.6%), as well as a significantly greater rate of perioperative complications (31% vs. 21.5%). The elderly patients had a significant 44% increased risk of perioperative complications compared with younger patients.

Additionally, subjects with chronic obstructive pulmonary disease (COPD) had a significant 1.8 times increased risk of perioperative complications compared with those without COPD.

With respect to specific complications, only paralytic ileus and pelvic hematoma requiring laparotomy occurred significantly more frequently in the older than the younger patients (7.1% vs. 2.6% and 1.4% vs. 0%, respectively). Mortality rates for the elderly and younger groups were not significantly different (0.6% and 0.5%).

 “COPD, ASA score and age appeared to be predictive of the postoperative risk of complications and morbidity following radical cystectomy,” the researchers wrote.

“Preoperative identification of these risk factors permits accurate risk stratification and the use of suitable preoperative medical management to reduce the risk of complications, e.g., conditioning airway status and initiating appropriate treatment in patients suffering from COPD.”

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