20 May Radical Cystectomy: Simple Test of Functional Status Identifies Higher Risk Patients
MedicalResearch.com Interview with:
Sarah P. Psutka, MD
Fellow in Urologic Oncology
Department of Urology, Mayo Clinic
MedicalResearch: What are the main findings of each study?
Dr. Psutka: In this study, we analyzed 1335 patients who underwent radical cystectomy at the Mayo clinic between 1996 and 2006. We categorized patients who stayed in the hospital longer than 10 days, putting them in the top 25th percentile of the length of stay, as having a prolonged hospital stay. We noted that prolonged hospital stay was associated with adverse postoperative outcomes, including serious complications and early postoperative death. Patients who had a prolonged length of stay had a higher burden of comorbidities, American Society of Anesthesiologist score, and their Eastern Cooperative Oncology Group Score. A multivariable analysis, holding these factors and other clinically relevant potential confounders constant, revealed that only the ECOG performance score independently predicted whether or not a patient had a prolonged hospital course following radical cystectomy.
MedicalResearch: Were any of the findings unexpected?
Dr. Psutka: Yes, it was surprising that other factors such as obesity, age, smoking status, and tumor severity did not significantly predict a challenging postoperative course. Only the ECOG performance status, a very simple and reproducible preoperative metric, essentially a component of the “eyeball test”, could distinguish those patients destined to have a prolonged hospital stay from those who would be able to be dismissed after a shorter hospital course.
MedicalResearch: What should clinicians and patients take away from each report?
Dr. Psutka: This study attempts to quantify what is commonly referred to as the “eye ball test” and provides a clinician with a reproducible clinical tool that can be used to predict prolonged hospitalization and adverse outcome following cystectomy. These results have implications for patient counseling, appropriate patient selection for radical cystectomy, and diversion of patient at risk to alternative, non-surgical therapies.
MedicalResearch: What recommendations do you have for future research as a result of each study?
Dr. Psutka: Future studies might seek to further understand other key factors, some potentially modifiable, that could be used to quantify and objectify clinical assessment and triage of patients prior to surgical therapy for bladder cancer.
2 Department of Health Services Research, Mayo Clinic, Rochester, Minnesota