A. A. Henderson1, M. Prunty2, T. Haden1, G. Petroski3, B. Ge3, N. Pokala1, M. Wakefield1, R. Kruse4, D. Mehr4, K. Murray1, K. Murray1 1University Of Missouri,Department Of Surgery-Division Of Urology,Columbia, MO, USA 2University Of Missouri,School Of Medicine,Columbia, MO, USA 3University Of Missouri,Office Of Medical Research,Columbia, MO, USA 4University Of Missouri,Family And Community Medicine,Columbia, MO, USA
Introduction: Radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer. This is a major surgery that can impair patients’ ability to perform activities of daily living (ADLs) and lead to admission to a nursing home (NH) post-operatively. The goal of this study is to evaluate changes in functional status and ADLs in patients who required NH care both pre- and postoperatively following RC.
Methods: Medicare inpatient claims were linked with NH assessment data to identify patients undergoing RC who required a nursing home stay at hospital discharge. The Minimum Data Set (MDS)-ADL Long Form score (0−28; higher equals greater functional impairment) is based on seven activities of daily living (ADLs). MDS scores were compared pre- and post-operatively for patients who were initially residing in NH prior to RC and scores were evaluated postoperatively for patients who were initially living independently but went to NH after RC. Paired t-test was used for comparison between groups and multiple regression modeling was used to evaluate additional variables.
Results: The dataset identified 471 patients that underwent RC and had at least one completed MDS−ADL assessment. Within this group, 245 patients lived at home prior to RC but were admitted to a NH after RC; 122 patients lived at a NH prior to RC and returned to the NH post-operatively. Mean age was 80.8±5.4 years. Most patients were Caucasian (92%) and male (71%). The median length of hospitalization after RC was 12 days.
Of the 245 patients who lived at home before RC, 84% of patients were discharged directly to a NH and 16% were discharged to another location before NH admission. There was no statistical difference in MDS−ADL score if patients went directly to NH upon leaving the hospital or to another location prior to NH (score 16 vs 15.2, p=0.39). Baseline MDS-ADL scores are not available for patients living independently prior to RC.
Among the patients who lived in a NH both before and after RC, the mean pre- and post-operative MDS-ADL scores were significantly different (score 12.1 and 16.6, p<0.0001).
Conclusion: RC leads to significant decline in functional status as measured by ADLs. The score of ADLs upon NH admission was high, representing an overall low functional status. The utilization of ADLs prior to and throughout hospitalization after RC may be beneficial in determining need for post-operative care and assistance.