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Purpose <p>This study aims to compare the impact of biological versus chronological age on postoperative risk after radical cystectomy (RC) by evaluating whether age ≥ 80 years independently predicts short-term mortality, complications and readmission rates beyond physiological status and comorbidity burden.</p> Methods <p>We retrospectively analysed 879 patients undergoing open RC at a high-volume centre between 2015 and 2024. Propensity score matching (PSM; 1:1 nearest neighbor) was performed to balance octogenarians (80–89 years) and patients &lt; 80 years for key covariates including ASA score, CCI score, BMI, renal function, preoperative albumin levels and urinary diversion. Primary endpoints were 30-day and 90-day mortality. Secondary endpoints included major complications (Clavien-Dindo ≥IIIb), 30- and 90-day readmission rates.</p> Results <p>Among 879 patients, 114 (13%) were octogenarians. Primary analyses demonstrated a higher 30-day (6.1% vs. 1.4%; <i>p</i> = 0.003) and 90-day mortality (10.5% vs. 3.9%; <i>p</i> = 0.004) in octogenarians compared to patients &lt; 80 years. After PSM (<i>n</i> = 194), mortality remained numerically higher in octogenarians (30-day: 6.2% vs. 2.1%; 90-day: 10.3% vs. 4.1%); however, these differences did not reach statistical significance (<i>p</i> = 0.28 and <i>p</i> = 0.165). Major complication and readmission rates were comparable between matched cohorts. In the multivariable regression analysis, age ≥ 80 years was not an independent predictor of any adverse outcome. Limitations include the retrospective design, single-centre setting and limited number of events after PSM.</p> Conclusion <p>When comorbidity burden and physiological fitness are comparable, octogenarians undergoing RC achieve short-term outcomes similar to those of younger patients. Chronological age alone should not preclude consideration of RC. Individualised risk assessment, treatment in experienced, high-volume centres and most likely, increasing adoption of robot-assisted RC are essential for safe surgical care for older RC candidates.</p>

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Radical cystectomy in octogenarians: a propensity score-matched analysis of short-term outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Maurin Helen Mangold,
  • Luisa Egen,
  • Nicolas Carl,
  • Luisa Vivienne Renner,
  • Alexander Studier-Fischer,
  • Caelán Max Haney-Aubert,
  • Maren Juliane Wenk,
  • Maurice Stephan Michel,
  • Niklas Westhoff,
  • Karl-Friedrich Kowalewski

摘要

Purpose

This study aims to compare the impact of biological versus chronological age on postoperative risk after radical cystectomy (RC) by evaluating whether age ≥ 80 years independently predicts short-term mortality, complications and readmission rates beyond physiological status and comorbidity burden.

Methods

We retrospectively analysed 879 patients undergoing open RC at a high-volume centre between 2015 and 2024. Propensity score matching (PSM; 1:1 nearest neighbor) was performed to balance octogenarians (80–89 years) and patients < 80 years for key covariates including ASA score, CCI score, BMI, renal function, preoperative albumin levels and urinary diversion. Primary endpoints were 30-day and 90-day mortality. Secondary endpoints included major complications (Clavien-Dindo ≥IIIb), 30- and 90-day readmission rates.

Results

Among 879 patients, 114 (13%) were octogenarians. Primary analyses demonstrated a higher 30-day (6.1% vs. 1.4%; p = 0.003) and 90-day mortality (10.5% vs. 3.9%; p = 0.004) in octogenarians compared to patients < 80 years. After PSM (n = 194), mortality remained numerically higher in octogenarians (30-day: 6.2% vs. 2.1%; 90-day: 10.3% vs. 4.1%); however, these differences did not reach statistical significance (p = 0.28 and p = 0.165). Major complication and readmission rates were comparable between matched cohorts. In the multivariable regression analysis, age ≥ 80 years was not an independent predictor of any adverse outcome. Limitations include the retrospective design, single-centre setting and limited number of events after PSM.

Conclusion

When comorbidity burden and physiological fitness are comparable, octogenarians undergoing RC achieve short-term outcomes similar to those of younger patients. Chronological age alone should not preclude consideration of RC. Individualised risk assessment, treatment in experienced, high-volume centres and most likely, increasing adoption of robot-assisted RC are essential for safe surgical care for older RC candidates.