David M Golombos1, Padraic O'Malley2, Patrick Lewicki2, Daniel P Nguyen3, Benjamin V Stone2, Bashir Al Hussein Al Awamlh2, Douglas S Scherr2. 1. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA. dag2042@med.cornell.edu. 2. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Starr Pavilion, 9th Floor, New York, NY, 10065, USA. 3. Department of Urology, Bern University Hospital, Bern, Switzerland.
Abstract
PURPOSE: To examine if patients of lower socioeconomic status (SES) are at higher risk of perioperative complications and experience different oncologic outcomes after radical cystectomy (RC). METHODS: Retrospective review was performed on 383 consecutive non-metastatic patients who underwent definitive RC at a tertiary referral center. Along with clinical and pathologic parameters traditionally utilized for risk stratification, potential social determinants of health were estimated using US Census data. Zip code-derived proxies of SES included median annual household income and percentage of residents completing high school education. Patients were grouped based on SES parameters, and potential differences were assessed. Multivariable logistic regression was then performed to identify predictors of complication within 90 days of RC. Survival outcomes were plotted using Kaplan-Meier survival curves. RESULTS: Overall, 167 (46.2%) patients suffered any complication within 90 days of RC. On multivariable analysis, length of stay (p ≤ 0.001), lower income grouping (p = 0.03), and lowest education tertile (p = 0.007) were significant predictors of any complication. Income (p = 0.04) and education (p = 0.008) groupings remained significant predictors in a subset analysis looking specifically at post-discharge complications. No significant differences in recurrence-free or overall survival estimates were observed among education (log-rank test: p > 0.9 and p = 0.6, respectively) or income (log-rank test: p = 0.2 and p = 0.09, respectively) groupings. CONCLUSION: Patients of lower socioeconomic status who undergo RC for bladder cancer are at increased risk of perioperative complications. Further studies are needed to clarify this relationship, and to explore interventions aimed to improve outcomes.
PURPOSE: To examine if patients of lower socioeconomic status (SES) are at higher risk of perioperative complications and experience different oncologic outcomes after radical cystectomy (RC). METHODS: Retrospective review was performed on 383 consecutive non-metastatic patients who underwent definitive RC at a tertiary referral center. Along with clinical and pathologic parameters traditionally utilized for risk stratification, potential social determinants of health were estimated using US Census data. Zip code-derived proxies of SES included median annual household income and percentage of residents completing high school education. Patients were grouped based on SES parameters, and potential differences were assessed. Multivariable logistic regression was then performed to identify predictors of complication within 90 days of RC. Survival outcomes were plotted using Kaplan-Meier survival curves. RESULTS: Overall, 167 (46.2%) patients suffered any complication within 90 days of RC. On multivariable analysis, length of stay (p ≤ 0.001), lower income grouping (p = 0.03), and lowest education tertile (p = 0.007) were significant predictors of any complication. Income (p = 0.04) and education (p = 0.008) groupings remained significant predictors in a subset analysis looking specifically at post-discharge complications. No significant differences in recurrence-free or overall survival estimates were observed among education (log-rank test: p > 0.9 and p = 0.6, respectively) or income (log-rank test: p = 0.2 and p = 0.09, respectively) groupings. CONCLUSION:Patients of lower socioeconomic status who undergo RC for bladder cancer are at increased risk of perioperative complications. Further studies are needed to clarify this relationship, and to explore interventions aimed to improve outcomes.
Authors: Ahmed Q Haddad; Nirmish Singla; Neil Gupta; Ganesh V Raj; Arthur I Sagalowsky; Vitaly Margulis; Yair Lotan Journal: Urology Date: 2015-04 Impact factor: 2.649
Authors: Richard J Sylvester; Adrian P M van der Meijden; Willem Oosterlinck; J Alfred Witjes; Christian Bouffioux; Louis Denis; Donald W W Newling; Karlheinz Kurth Journal: Eur Urol Date: 2006-01-17 Impact factor: 20.096
Authors: D Robert Siemens; William J Mackillop; Yingwei Peng; Xuejiao Wei; David Berman; Christopher M Booth Journal: Urol Oncol Date: 2015-07-18 Impact factor: 3.498
Authors: Pranav Sharma; Carl H Henriksen; Kamran Zargar-Shoshtari; Ren Xin; Michael A Poch; Julio M Pow-Sang; Wade J Sexton; Philippe E Spiess; Scott M Gilbert Journal: J Urol Date: 2015-07-31 Impact factor: 7.450
Authors: Beth Russell; Mieke V Hemelrijck; Truls Gårdmark; Lars Holmberg; Pardeep Kumar; Andrea Bellavia; Christel Häggström Journal: Cancer Med Date: 2020-08-26 Impact factor: 4.452