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Dementia and Frailty Impact Postoperative Care Trajectories and Burden among Older Adults Undergoing Radical Cystectomy for Bladder Cancer
Ernandez J, Xiang L, Adler R, Hsu J, Shah S, Kim D, Gershman B, Mossanen M et al.. medRxiv, 2026-06-06
Topic: Health services, long-term care and technology
OBJECTIVE Bladder cancer (BC) is predominantly a disease of older, comorbid adults, and radical cystectomy (RC), which is the gold standard treatment, carries considerable morbidity. We sought to determine the impact of baseline dementia and frailty on the care trajectory beyond the immediate postoperative period. We hypothesized that frail patients and those with dementia undergoing RC for BC will have poorer care trajectories. METHODS AND MATERIALS We identified Medicare beneficiaries ≥ 66 years old who underwent RC for BC in 2017 with 12 months of pre- and post-RC enrollment. Frailty and dementia were characterized using validated, claims-based measures. Associations between baseline frailty and dementia with postoperative care trajectory outcomes were determined using Fine-Gray competing risk models. RESULTS We identified 3,600 beneficiaries of whom 11.6% were frail and 3.4% met criteria for dementia. Patients with dementia were more likely to be frail, comorbid, and not receive standard-of-care neoadjuvant chemotherapy. Frailty was independently associated with ≥ 2 transitions in care level after index discharge from RC and skilled nursing facility (SNF) admissions within 1 year of RC, exposure to intensive post-RC interventions, including dialysis and feeding tube placement, and poorer survival. Dementia remained associated with SNF admissions regardless of frailty level CONCLUSIONS Among a contemporary cohort of older adults undergoing RC for BC, preoperative dementia and frailty were independently associated with poorer care trajectory beyond the immediate postoperative period after RC. Our work highlights a role for preoperative geriatric assessment in identifying and optimizing patients at greatest risk.
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APA 7th
Ernandez, J., Xiang, L., Adler, R., Hsu, J., Shah, S., Kim, D., et al. (2026). Dementia and Frailty Impact Postoperative Care Trajectories and Burden among Older Adults Undergoing Radical Cystectomy for Bladder Cancer. medRxiv. https://doi.org/10.64898/2026.06.04.26354768
Vancouver
Ernandez J, Xiang L, Adler R, Hsu J, Shah S, Kim D, et al. Dementia and Frailty Impact Postoperative Care Trajectories and Burden among Older Adults Undergoing Radical Cystectomy for Bladder Cancer. medRxiv. 2026. doi:10.64898/2026.06.04.26354768.
BibTeX
@article{ernandez2026-dedcf5be,
author = {Ernandez, J. and Xiang, L. and Adler, R. and Hsu, J. and Shah, S. and Kim, D. and Gershman, B. and Mossanen, M. and others},
title = {{Dementia and Frailty Impact Postoperative Care Trajectories and Burden among Older Adults Undergoing Radical Cystectomy for Bladder Cancer}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.06.04.26354768},
url = {https://doi.org/10.64898/2026.06.04.26354768}
}
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Key findings
- RESULTS We identified 3,600 beneficiaries of whom 11.6% were frail and 3.4% met criteria for dementia.
- Frailty was independently associated with ≥ 2 transitions in care level after index discharge from RC and skilled nursing facility (SNF) admissions within 1 year of RC, exposure to intensive post-RC interventions, including dialysis and feeding tube placement, and poorer survival.
- Dementia remained associated with SNF admissions regardless of frailty level CONCLUSIONS Among a contemporary cohort of older adults undergoing RC for BC, preoperative dementia and frailty were independently associated with poorer care trajectory beyond the immediate postoperative period after RC.
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Study details
- Effect size11.6%; 3.4%
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 27 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 17 of the 62 points we could judge it on, which is 27 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 17 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 17 of the 62 points we could judge it on is 27 out of 100. |
| Total | 27 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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