{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:30:11Z","timestamp":1790829011259,"version":"4.1.0"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Helios Center for Research and Innovation","award":["2021\u20130431"],"award-info":[{"award-number":["2021\u20130431"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Bladder cancer (BC) predominantly affects older patients, and their multidisciplinary treatment often includes surgical intervention. Frailty can influence treatment decisions and is associated with poorer outcomes. This study analyses trends in demographics, treatment patterns and frailty in a large, nationwide, real-world inpatient cohort in Germany. Methods: This retrospective observational study included a total of 49,139 consecutive patients, who received inpatient care for BC at all HELIOS hospitals in Germany between 2016 and 2022. Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and categorised as low (&lt;5), intermediate (5\u201315), or high (&gt;15). Trends in HFRS, treatment modalities, and demographic variables were analysed using regression models and compared between the periods 2016\u20132019 and 2020\u20132022. Results: Of the 49,139 patients, 27,979 were treated between 2016\u20132019 and 21,160 between 2020\u20132022. Patients treated in the later period were slightly older but had a lower comorbidity index. The proportion of patients with low frailty increased (73.4% vs. 75.5%, p &lt; 0.01), intermediate frailty decreased (23.5% vs. 21.5%, p &lt; 0.01) and the proportion of highly frail patients remained stable at 3.0% (p = 0.95). Rates of transurethral resection declined over time, whereas rates of RC remained stable (p = 0.12). The use of systemic therapy increased (p = 0.003), particularly among low frailty elderly patients. Early intravesical chemotherapy following transurethral resection declined significantly in 2020\u20132022 (p &lt; 0.001), particularly among elderly patients with high frailty. Mean length of hospital stay decreased by one day, while ICU admission rates and in-hospital mortality remained stable across time periods. Conclusions: This study shows frailty-specific changes in hospitalisation patterns and inpatient management of BC in Germany, underscoring the value of frailty assessment in population-based research. The proportion of patients classified as having low frailty increased over time. Significant changes in the use of intravesical chemotherapy and systemic therapy were associated with frailty. The decline in early intravesical chemotherapy may have implications for recurrence risk and downstream healthcare utilisation.<\/jats:p>","DOI":"10.3390\/life16010169","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T08:48:08Z","timestamp":1768985288000},"page":"169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Trends in the Management of Bladder Cancer with Emphasis on Frailty: A Nationwide Analysis of More Than 49,000 Patients from a German Hospital Network"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4392-6861","authenticated-orcid":false,"given":"Tobias","family":"Klatte","sequence":"first","affiliation":[{"name":"Department of Urology, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany"},{"name":"Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"Bold","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg, Germany"},{"name":"Department of Anaesthesiology and Intensive Care Medicine, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6698-8600","authenticated-orcid":false,"given":"Julius","family":"Dengler","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg, Germany"},{"name":"Department of Neurosurgery, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"de Martino","sequence":"additional","affiliation":[{"name":"Department of Urology, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9708-1593","authenticated-orcid":false,"given":"Sven","family":"Hohenstein","sequence":"additional","affiliation":[{"name":"Real World Evidence and Health Technology Assessment, Helios Health Institute, 13125 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Kuhlen","sequence":"additional","affiliation":[{"name":"Real World Evidence and Health Technology Assessment, Helios Health Institute, 13125 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5441-3906","authenticated-orcid":false,"given":"Andreas","family":"Bollmann","sequence":"additional","affiliation":[{"name":"Real World Evidence and Health Technology Assessment, Helios Health Institute, 13125 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Steiner","sequence":"additional","affiliation":[{"name":"Department of Urology, Helios Klinikum Erfurt, 99089 Erfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora F.","family":"Dengler","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg, Germany"},{"name":"Department of Neurosurgery, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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