OBJECTIVE: To show the underlying variability in peri-operative mortality after radical cystectomy (RC) by analysing failure-to-rescue (FTR) rates, i.e. deaths after complications. MATERIALS AND METHODS: Patients undergoing RC for non-metastatic bladder cancer (BCa) were identified from the Nationwide Inpatient Sample, 1999-2009, resulting in a weighted estimate of 79,972 patients. The FTR rates were assessed according to patient and hospital characteristics, as well as complication type. Generalized linear regression analyses were performed. RESULTS: Overall, 26,740 patients had a complication, corresponding to a FTR rate of 5.5%. Septicaemia (odds ratio [OR]: 13.41, P < 0.001) and cardiac (OR: 3.97, P < 0.001), wound-related (OR: 2.12, P < 0.001), genitourinary (OR: 1.62, P = 0.045) and haematological (OR: 1.78, P = 0.008) complications were associated with FTR. Older age (OR: 1.05, P < 0.001), increasing comorbidities (OR: 1.33, P < 0.001), Medicare (OR: 1.52, P = 0.016), and Medicaid insurance status (OR: 2.10, P = 0.029) were associated with higher odds of FTR. Conversely, increasing hospital volume (OR: 0.992, P = 0.014) reduced the odds of FTR. CONCLUSIONS: Whereas both patient and hospital characteristics were associated with increased odds of FTR, the occurrence of septicaemia and cardiac complications were the most strongly associated with a higher risk of in-hospital mortality.
OBJECTIVE: To show the underlying variability in peri-operative mortality after radical cystectomy (RC) by analysing failure-to-rescue (FTR) rates, i.e. deaths after complications. MATERIALS AND METHODS:Patients undergoing RC for non-metastatic bladder cancer (BCa) were identified from the Nationwide Inpatient Sample, 1999-2009, resulting in a weighted estimate of 79,972 patients. The FTR rates were assessed according to patient and hospital characteristics, as well as complication type. Generalized linear regression analyses were performed. RESULTS: Overall, 26,740 patients had a complication, corresponding to a FTR rate of 5.5%. Septicaemia (odds ratio [OR]: 13.41, P < 0.001) and cardiac (OR: 3.97, P < 0.001), wound-related (OR: 2.12, P < 0.001), genitourinary (OR: 1.62, P = 0.045) and haematological (OR: 1.78, P = 0.008) complications were associated with FTR. Older age (OR: 1.05, P < 0.001), increasing comorbidities (OR: 1.33, P < 0.001), Medicare (OR: 1.52, P = 0.016), and Medicaid insurance status (OR: 2.10, P = 0.029) were associated with higher odds of FTR. Conversely, increasing hospital volume (OR: 0.992, P = 0.014) reduced the odds of FTR. CONCLUSIONS: Whereas both patient and hospital characteristics were associated with increased odds of FTR, the occurrence of septicaemia and cardiac complications were the most strongly associated with a higher risk of in-hospital mortality.
Authors: Giorgio Gandaglia; Briony Varda; Akshay Sood; Daniel Pucheril; Ramdev Konijeti; Jesse D Sammon; Shyam Sukumar; Mani Menon; Maxine Sun; Steven L Chang; Francesco Montorsi; Adam S Kibel; Quoc-Dien Trinh Journal: Can Urol Assoc J Date: 2014-09 Impact factor: 1.862
Authors: Matthew E Nielsen; Katherine Mallin; Mark A Weaver; Bryan Palis; Andrew Stewart; David P Winchester; Matthew I Milowsky Journal: BJU Int Date: 2014-05-22 Impact factor: 5.588
Authors: Valérie M Smit-Fun; Dianne de Korte-de Boer; Linda M Posthuma; Annick Stolze; Carmen D Dirksen; Markus W Hollmann; Wolfgang F Buhre; Christa Boer Journal: Trials Date: 2018-10-26 Impact factor: 2.279