Radical cystectomy in the elderly: national trends and disparities in perioperative outcomes and quality of care.
BACKGROUND
To examine national trends of radical cystectomy (RC) for urothelial carcinoma of urinary bladder in octogenarian patients and to assess the rates of adverse outcomes.


METHODS
Within the Nationwide Inpatient Sample (NIS), we focused on RCs performed between 1998 and 2007. Age was stratified as <80 versus ≥80 years. Propensity-based matched analyses were used to account for treatment selection biases. Generalized linear regression analyses were fitted to predict adverse perioperative events according to age.


RESULTS
Of 12,274 RC patients, 1,605 were ≥80 years (13.1%). The RC rates in octogenarians increased significantly from 9.9% in 1998 to 13.7% in 2007. Most elderly patients were treated at low-/intermediate-volume hospitals (81.7%) and nonacademic centers (60.6%). After propensity score matching, the inpatient mortality rate was higher in octogenarians (4.6 vs. 2.6%, p < 0.001). In multivariable analyses, octogenarians were at increased risk of blood transfusions (OR: 1.30) and postoperative complications (OR: 1.22).


CONCLUSIONS
Most octogenarians undergoing RC are treated at low-/intermediate-volume hospitals and at nonacademic centers. The inpatient hospital mortality is about twice as high in these patients, and adverse perioperative outcomes are more frequent. Such patients may benefit from RC at high-volume and/or academic centers to maximally reduce adverse perioperative outcomes.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Florian
F
Roghmann
Shyam
S
Sukumar
Praful
P
Ravi
Vincent Q
VQ
Trinh
Malek
M
Meskawi
Khurshid R
KR
Ghani
Jesse D
JD
Sammon
Ariella A
AA
Friedman
James O
JO
Peabody
Mani
M
Menon
Joachim
J
Noldus
Pierre I
PI
Karakiewicz
Maxine
M
Sun
Quoc-Dien
QD
Trinh
D000046:Academic Medical Centers / Q000639:trends; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards / Q000639:trends*; D054625:Healthcare Disparities / Q000592:standards / Q000639:trends*; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000639:trends; D061846:Hospitals, Low-Volume / Q000639:trends; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000592:standards / Q000639:trends*; D010360:Patient Transfer; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D057216:Propensity Score; D011787:Quality of Health Care / Q000592:standards / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*