Cancer Management and Research (May 2018)
Cystectomy for bladder cancer in elderly patients is not associated with increased 30- and 90-day mortality or readmission, length of stay, and cost: propensity score matching using a population database
Abstract
Wei-Yu Lin,1–3,* Chun-Te Wu,3,4 Miao-Fen Chen,5 Ying-Hsu Chang,6 Cheng-Li Lin,7,8 Chia-Hung Kao9–11,* 1Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan; 2Nursing Department, Chang Gung University of Science and Technology, Chia-Yi, Taiwan; 3Department of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Department of Urology, Chang Gung Memorial Hospital, Keelung, Taiwan; 5Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan; 6Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, LinKo, Taiwan; 7Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 8School of Medicine, China Medical University, Taichung, Taiwan; 9Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan; 10Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; 11Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan *These authors contributed equally to this work Purpose: Radical cystectomy (RC) is an effective but underused treatment for bladder cancer in elderly patients. This study performed analysis of propensity scores (PSs) to determine the outcomes of RC for elderly patients, with results generalizable at the population-based level.Patients and methods: We conducted a population-based, retrospective cohort study of patients who underwent RC in Taiwan during 2000–2010. Multivariable logistic regression was implemented to evaluate 30- and 90-day mortality and readmission rates, length of intensive care unit (ICU) stay, length of hospital stay (LOS), and cost. Enrolled patients were divided into younger (≤75 years) and older groups (>75 years) who were matched according to their PSs.Results: We identified 430 patients with bladder cancer who underwent RC between 2000 and 2010. Older age was not significantly associated with 30-day readmission (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.38–1.70), 90-day readmission (OR = 1.10, 95% CI = 0.60–2.00), 30-day mortality (OR = 3.07, 95% CI = 0.31–30.0), or 90-day mortality (OR = 2.98, 95% CI = 0.91–9.70) in the PS-matched group. Similar trends were also observed for both groups regarding the mean length of ICU stay, LOS, and overall medical expenditure within the same admission.Conclusion: No significant differences existed between the older and younger groups for 30- and 90-day mortality and readmission rates, length of ICU stay, LOS, and medical expenditure in patients undergoing RC for bladder cancer. Some healthy elderly patients may be good candidates for this extensive curative treatment. Keywords: cystectomy, bladder cancer, elderly, mortality, readmission, cost
