title: Perioperative complications and 90-day mortality of radical cystectomy in the elderly (75+): a retrospective, multicentre study.
abstract: OBJECTIVE
  To assess perioperative complications and 90-day mortality of radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC).
  
  
  METHODS
  This is a retrospective, multicentre (n = 11) study of a consecutive series of patients ≥75 years who underwent RC for MIBC between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification.
  
  
  RESULTS
  A total of 256 patients with a mean age of 79.6 years (range 75.0-86.6) were analysed. Urinary diversion with the use of bowel was performed in 79.5% and ureterocutaneostomy in 20.5%, with a higher proportion in the ≥80 cohort (32.2 vs. 14%; p = 0.001). 41.4% of patients had an uneventful postoperative course (Clavien grade 0) and 26.6% developed severe complications (Clavien grade III-V). In a multivariable regression analysis, the Charlson comorbidity index (odds ratio 1.5 per unit increase; p < 0.001) and the body mass index (odds ratio 1.13 per kg/m(2) increase; p = 0.015) were predictors for the development of complications. The 90-day mortality rate was 9% and the independent correlates thereof were the development of severe medical complications (p = 0.004), the American Society of Anesthesiologists (ASA) score (p = 0.03) and age (p = 0.005).
  
  
  CONCLUSIONS
  Morbidity and 90-day mortality of RC in the elderly remain substantial. The interrelation between comorbidity, complication rate and 90-day mortality underlines the need for a comprehensive geriatric assessment of elderly patients with MIBC in whom RC is indicated.
authors.affiliation: Landesklinikum Wiener Neustadt, Wien, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Berger
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.forename: Clemens
authors.initials: C
authors.lastname: Wehrberger
authors.forename: Eva
authors.initials: E
authors.lastname: Comploj
authors.forename: Anton
authors.initials: A
authors.lastname: Ponholzer
authors.forename: Martina
authors.initials: M
authors.lastname: Wolfgang
authors.forename: Eckart
authors.initials: E
authors.lastname: Breinl
authors.forename: Michael
authors.initials: M
authors.lastname: Dunzinger
authors.forename: Johann
authors.initials: J
authors.lastname: Hofbauer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Höltl
authors.forename: Klaus
authors.initials: K
authors.lastname: Jeschke
authors.forename: Steffen
authors.initials: S
authors.lastname: Krause
authors.forename: Walter
authors.initials: W
authors.lastname: Kugler
authors.forename: Walter
authors.initials: W
authors.lastname: Pauer
authors.forename: Michael
authors.initials: M
authors.lastname: Rauchenwald
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009132:Muscles / Q000473:pathology; D059035:Perioperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion; D014945:Wound Healing