Age Adjusted Charlson Comorbidity Index: Predictor of 90-Day Mortality after Radical Cystectomy

Objective: To evaluate the impact of age adjusted Charlson's comorbidity index (ACCI) in predicting 90-day mortality in patients undergoing radical cystectomy for Muscle Invasive Bladder Cancer (MIBC) in a low volume center. Methods: Retrospective cohort study performed at a university hospital during a period of 1989 to 2012. Charts were reviewed for various clinical, demographic factors in ascertaining the ACCI. The data was computed and analyzed to determine the 90-day mortality. Logistic regression was applied to determine association between Charlson's co-morbidity index and 90 day mortality. Results: 201 had radical cystectomy (RC) for muscle invasive bladder cancer (MIBC) during the period, however, 175 patients were found eligible and reviewed, 16 excluded for incomplete record or loss to followup. Baseline variables were comparable among the three categories of ACCI. Fourteen patients died during 90-day period (8%) and eight out of them had ACCI ≥4. On univariate regression analysis, high ACCI score, histology and adjuvant chemotherapy was found to be statistically significant variables; however, on multivariate regression only high ACCI score and histology were strong predictors of 90-day postoperative mortality. ACCI >4 and histology squamous cell cancer (SCC) increases the odds of 90 days post-operative mortality by 13 fold. Conclusions: Age adjusted CCI >4 and tumor histology are significantly associated with 90 days postoperative mortality in patients undergoing radical cystectomy for muscle invasive urothelial cancer. Therefore, these variables should be taken into account while deciding about patient management preoperatively. Appropriate patient counseling and preparation should be done to reduce post-operative mortality. Volume 1 | Issue 2