MP22-13 FRAILTY ADAPTED ERAS PATHWAY FOR PATIENTS WITH BLADDER CANCER REQUIRING SURGERY: THE GLOBAL RADICAL CYSTECTOMY EVALUATION AND MANAGEMENT (GRACEM) STUDY PROTOCOL

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-13 FRAILTY ADAPTED ERAS PATHWAY FOR PATIENTS WITH BLADDER CANCER REQUIRING SURGERY: THE GLOBAL RADICAL CYSTECTOMY EVALUATION AND MANAGEMENT (GRACEM) STUDY PROTOCOL Filippo Dagnino, Roberto Contieri, Bruno Bernardini, Federico Piccioni, Stefano Mancon, Pietro Brin, Manuela Pastore, Vittorio Fasulo, Marco Paciotti, Giovanni Lughezzani, Alberto Saita, Nicolò Maria Buffi, Paolo Casale, Massimo Lazzeri, and Rodolfo Hurle Filippo DagninoFilippo Dagnino , Roberto ContieriRoberto Contieri , Bruno BernardiniBruno Bernardini , Federico PiccioniFederico Piccioni , Stefano ManconStefano Mancon , Pietro BrinPietro Brin , Manuela PastoreManuela Pastore , Vittorio FasuloVittorio Fasulo , Marco PaciottiMarco Paciotti , Giovanni LughezzaniGiovanni Lughezzani , Alberto SaitaAlberto Saita , Nicolò Maria BuffiNicolò Maria Buffi , Paolo CasalePaolo Casale , Massimo LazzeriMassimo Lazzeri , and Rodolfo HurleRodolfo Hurle View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Enhanced Recovery After Surgery (ERAS) protocols have become the standard of care but may result in inadequate assessment of comorbidities and frailties. In this study we present a new multidisciplinary clinical pathway: the Global RAdical Cystectomy Evaluation and Management (GRACEM), designed for patients requiring RC and focused on frailties, comorbidities and nutritional status. METHODS: The GRACEM pathway is a single-center 2-year prospective cohort quality improvement study. Ethical approval ICH (N° 3317; 18/11/2022). Patients requiring curative and salvage RC for curative intent were recruited. We developed the Functional Limitation and Geriatric Syndromes Frailty Questionnaire (FLIGS-FQ) ad hoc for frailty screening and as a health outcome measure of GRACEM patients. One month before surgery, patients were contacted and administered the FLIGS-FQ, the Nutritional Risk Screening (NRS-2002) and the EQ5D5L to assess patient's frailty, nutritional status and quality of life (QoL). Anthropometric data and specific blood tests were also collected. Cases were discussed in the weekly multidisciplinary meeting (case manager, urologist, anesthesiologist, geriatrician, nutritionist, and physiotherapist) who coordinates risk-adapted diagnostic and therapeutic decisions. As outcomes, we use the American College of Surgeons' National Quality Improvement Program in Surgery calculator (ACS-NSQIP) and the Preoperative Score to Predict Postoperative Mortality (POSPOM) for predicting the risk of 30-day and 90-day mortality. RESULTS: Thirty-one patients were invited and twenty-seven enrolled. Out of 27 patients, twenty-five underwent curative RC and two salvage RC. The mean age at surgery is 76 years old, the mean BMI value is 25. All patients included were males with pT>2 BC. Preliminary results show that all of the included patients did the questionnaires for personal evaluation of GRACEM work-up. The reported mean score is 8.7 (SD 0.9), 8.2 (SD 1.4), 9.1 (SD 1.2) for GRACEM pathway usefulness, manageability and satisfaction personal evaluation, measured in a range from 5 to 10, respectively. For pre-RC and post-RC (30 days) global health-condition self-evaluation, we reported respectively a mean score of 68.5 (SD 23.1) and 62.2 (SD 15.8) measured in a range from 10 to 100 for pre-RC assessment and from 20 to 85 for post-RC assessment. We reported a mean length of stay of 11.6 (SD 6.2) days and a Clavien<3 and>3 rate of 61% and 39%, respectively. No mortality was observed at 90 days. CONCLUSIONS: Our preliminary findings seem to support the adoption of Global RAdical Cystectomy Evaluation and Management (GRACEM) study protocol for patients who are scheduled for RC. Larger sample size, extended follow up and external validation remain mandatory before routine clinical use. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e347 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Filippo Dagnino More articles by this author Roberto Contieri More articles by this author Bruno Bernardini More articles by this author Federico Piccioni More articles by this author Stefano Mancon More articles by this author Pietro Brin More articles by this author Manuela Pastore More articles by this author Vittorio Fasulo More articles by this author Marco Paciotti More articles by this author Giovanni Lughezzani More articles by this author Alberto Saita More articles by this author Nicolò Maria Buffi More articles by this author Paolo Casale More articles by this author Massimo Lazzeri More articles by this author Rodolfo Hurle More articles by this author Expand All Advertisement PDF downloadLoading ...