Introduction:

Elderly and frail patients have higher postoperative complication and mortality rates. Geriatric comanagement has been proposed as a potential strategy to mitigate complications, however, has not been well characterized among patients with urologic malignancies. In this prospective study, we investigate the 90 day postoperative complication and mortality among patients admitted for urologic cancers.

Methods:

Starting January 2023, we created an interdisciplinary inpatient comanagement program with the Geriatrics Division. Patients were eligible for comanagement if age 75 or older, undergoing a procedure, admitted with a complication related to cancer treatment, and staying for 2 days or more as an inpatient. Propensity score matching was used to adjust for potential confounders. We utilized an interrupted time series analysis comparing 18 month pre- and 18 month post- intervention, with a one month washout period for implementation, evaluating 90 day postoperative complication and mortality rates. Frailty was assessed with the RAI score, with an RAI score > 37 indicating significant frailty. All patients in the geriatric comanagement program were seen by the geriatrician starting postoperative day 1 until discharge. Significant postoperative complications were defined as Clavien-Dindo grade III or higher.

Results:

Overall, 120 patients were enrolled in the geriatric comanagement, and matched to 120 patients hospitalized before implementation of the comanagement program. Most patients were male (68%), and 83% had an RAI score of 37+. Overall, significant postoperative complications were higher among the non-comanagement group (13.3%) compared to the comanagement group (5%, p<0.05). Postoperative delirium was significantly more common among the non-comanangement group (21.7%) compared to the non-comanagement group (5%, p<0.05). Although rates of 90-day mortality rates were lower among comanagement patient (3%) vs. non-comanagement (6%), the differences approached but were not statistically significant (p=0.2). The median length of stay was shorter among comanagement patients (7 days, IQR 5-10), vs. non-comanagemement patients (9 days, IQR 7-12). Rates of speech and swallow rehabilitation and nutrition services were higher among the comanagement group.

Conclusion:

Geriatric comanagement was associated with a significantly lower post-operative complication rate and shorter length of stay among older patients with cancer. These findings suggest that such patients may benefit from geriatric comanagement, which could improve their ability to survive adverse postoperative events.

Funding: N/A