Factors Influencing Physical Therapy Utilization in Urologic Oncology Patients Undergoing Major Surgery

Background: Frailty is frequently observed among patients undergoing major oncologic surgery, yet physical therapy (PT) utilization in urologic oncology remains underreported. This study aimed to identify predictors of inpatient PT utilization and assess its impact on functional outcomes using the Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” tool. Methods: The Emory Frailty Database was retrospectively reviewed, including patients ≥18 years who underwent urologic oncologic surgery from 2013 to 2019. Demographics, comorbidities, frailty status, surgical approach, hospital length of stay (LOS), and discharge destination were collected. Utilization of PT, number of sessions, and “6-Clicks” scores were recorded. Multivariable regression assessed predictors of PT utilization. Pre- and post-PT “6-Clicks” scores were compared using Wilcoxon signed-rank tests. Results: Of 194 patients, 54 (27.8%) received inpatient PT. Patients receiving PT were more likely to be frail/pre-frail ( P = .005), have higher comorbidity burdens [Charlson comorbidity index (CCI) ≥ 4, P < .001], undergo open procedures ( P < .001), and experience prolonged LOS ( P < .001). On multivariable analysis, CCI ≥ 4 (OR 1.69, P = .04) and prolonged LOS (OR 1.69, P < .001) independently predicted PT utilization. Among 21 patients with pre- and post-intervention scores, median “6-Clicks” scores improved significantly (16-20, P = .003). 20 (44%) of frail/prefrail patients utilized PT postoperatively. Conclusion: Comorbidity burden and prolonged hospitalization, rather than frailty alone, independently predicted PT referral following urologic cancer surgery. Short-term functional outcomes significantly improved following PT, suggesting that standardized referrals based on objective criteria may optimize recovery and mitigate biases influencing referrals. Given fewer than 50% of frail patients utilized PT, implementation of frailty screening tools may improve postoperative outcomes.