The role of G8 screening tool in elderly population undergoing radical cystectomy: preliminary evaluation.
The G8 screening tool represents a valid instrument for the identification of functional decline in oncological geriatric patients (pts). Recently it has demonstrated good predictive value in surgery to identify fragile pts candidates for oncological abdominal surgery. Our study has the objective to define if G8 score is a good tool to identify the risk of post operative complications in elderly pts (? 70 years) undergoing radical cystectomy (RC).
From January 2012 to August 2017 we recruited 56 pts 70 yrs or older at the surgical time, undergone RC. Median age was 76 yrs (SD 4,37). The G8 screening questionnaire was perfomed to all patients preoperatively, and fragile pts were identified with a score ? 14. We registered intra operative complications, post operative complications and their gravity using Clavien Dindo scale, estimated glomerular filtration rate (eGFR) and its variation postoperatively, length of hospital stay after surgery and readmission rate within 30 days. We compared the clinicalpathological data between the frail (G8 score <=14) and not frail (G8 score >14) group. Statistical analysis was made by computing software SPSS.
Median preoperative G8 score was 13,65 (SD 2,3). Pts were divided in fragile (N=35, 62,5%) and fit (N=21, 37,5%). Intra operative complications were registered in 1 pts (2,8 %) with G8 score ?14 and 0 pt (0%) with G8>14 (p= 0,625). Post operative complications occurred in 24 pts (68,5 %) with G8 score ?14 and 8 pts (38,09 %) with G8>14 (p=0,025), 12 and none of them had a Clavien Score ? 3 respectevely (p= 0,015). Postoperative eGFR was 61,45 (SD 29,2) in G8?14 group and 57,66 (SD 25,84) in G8>14 group (p=0,62) and median variation between pre and postoperative eGFR was 7,8 (SD 27,43) and 8,0 (SD 26,01) for each group (p= 0,97). Median hospital stay was 25,45 days (SD 11,01) for fragile pts and 24,23 days (SD 11,32) for fit pts (p=0,69). 5 pts (14,28 %) with G8score?14 were readmitted within 30 days of discharge, and for 6 pts (28,57 %) with G8score>14 was necessary a new hospitalization (p= 0,298). No significative difference was registered for overall mortality (p= 0,23) and cancer related mortality (p= 0,53) between the two groups.
The G8 screening tool represents a good predictive instrument for RC morbidity, identifying fragile pts at risk of post operative complications and their severity. Further analyses are necessary to confirm the data obtained from this preliminary study.