title: Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy.
abstract: To investigate the modified frailty index (mFI) as a preoperative predictor of postoperative complications following radical cystectomy (RC) in patients with bladder cancer.
  
  
  
  Patients undergoing RC were identified from the National Surgical Quality Improvement Program participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to the National Surgical Quality Improvement Program comorbidities and activities of daily livings. The mFI groups were determined by the number of risk factors per patient (0, 1, 2, and≥3). Univariable and multivariable regression were performed to determine predictors of Clavien 4 and 5 complications, and a sensitivity analysis was performed to determine the mFI value that would be a significant predictor of Clavien 4 and 5 complications.
  
  
  
  Of the 2,679 cystectomy patients identified, 843 (31%) of patients had an mFI of 0, 1176 (44%) had an mFI of 1, 555 (21%) had an mFI of 2, and 105 (4%) had an mFI≥3. Overall, 1585 (59%) of patients experienced a Clavien complication. When stratified at a cutoff of mFI≥2, the overall complication rate was not different (61.7% vs. 58.3%, P = 0.1), but the mFI2 or greater group had a significantly higher rate of Clavien grade 4 or 5 complications (14.6% vs. 8.3%, P<0.001) and overall mortality rate (3.5% vs. 1.8%, P = 0.01) in the 30-day postoperative period. The multivariate logistic regression model showed independent predictors of Clavien grade 4 or 5 complications were age>80 years (odds ratio [OR] = 1.58 [1.11-2.27]), mFI2 (OR = 1.84 [1.28-2.64]), and mFI3 (OR = 2.58 [1.47-4.55]).
  
  
  
  Among patients undergoing RC, the mFI can identify those patients at greatest risk for severe complications and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, preoperative risk stratification is crucial to inform decision-making about surgical candidacy.
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: mchappi1@jhmi.edu.
authors.forename: Meera R
authors.initials: MR
authors.lastname: Chappidi
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Max
authors.initials: M
authors.lastname: Kates
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Hiten D
authors.initials: HD
authors.lastname: Patel
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tosoian
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Kaye
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Nikolai A
authors.initials: NA
authors.lastname: Sopko
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Danny
authors.initials: D
authors.lastname: Lascano
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Jen-Jane
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: McKiernan
authors.affiliation: The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D015653:Cystectomy; D005260:Female; D000073496:Frailty / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery*
keywords: Bladder cancer; Frailty; Perioperative outcomes; Radical cystectomy