Preoperative Geriatric Assessment to Predict Functional Outcome after Major Urologic Operations: Results from a Multicenter Study

Introduction Major urological tumor surgery entails a severe risk of unexpected adverse events, persistent functional deterioration, and death in older patients. The Erlangen Index (EI) geriatric assessment tool has previously been shown to predict incomplete functional recovery following major urological tumor surgery in an elderly patient collective. We prospectively evaluated assessment tools including EI in a multicenter setting. Materials and Methods A total of 340 patients over the age of 65 were assessed prospectively before and after cystectomy, prostatectomy, or renal tumor surgery at three academic centers in Germany and Austria. Endpoints were long-term functional deterioration (Activities of daily living (ADL) measured by Barthel-Index) at day 30 and day 180, and mortality at day 180. Results In this study 58 (17.0%) patients underwent cystectomy, 140 (41.2%) prostatectomy and 142 (41.8%) a kidney tumor operation. Mean age was 74.8 years. ADL impairment as a measure of incomplete recovery at day 30 and 180 after surgery were recorded in 47.6% and 37.4% of cases, respectively. The EI showed good sensitivity for mortality at day 180 (reference cohort: 85%, validation center 1: 100%, validation center 2: 50%) and for ADL impairment at day 180 (reference cohort 75.4%, validation center 1 72.3%, validation center 2 83.3%). Conclusion Elderly patients with a poor performance status have a high risk of persistent functional deterioration. Data from this multicenter external validation trial confirms the EI as an accurate and reliable tool to identify patients with high risk of mortality or persistent postoperative functional impairment.