Matthew Mossanen1,2,3, Ross E Krasnow4, Dimitar V Zlatev1, Wei Shen Tan5,6, Mark A Preston1,2, Quoc-Dien Trinh1,2,3, Adam S Kibel1,2, Guru Sonpavde2, Deborah Schrag2, Benjamin I Chung7, Steven L Chang1,2,7. 1. Division of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. 2. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. 3. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Urology, Georgetown University, Washington, DC, USA. 5. Division of Surgery and Interventional Sciences, Department of Urology, University College London, London, UK. 6. Department of Urology, Imperial College Healthcare, London, UK. 7. Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
Abstract
OBJECTIVE: To examine the incidence of perioperative complications after radical cystectomy (RC) and assess their impact on 90-day postoperative mortality during the index stay and upon readmission. PATIENTS AND METHODS: A total of 57 553 patients with bladder cancer (unweighted cohort: 9137 patients) treated with RC, at 360 hospitals in the USA between 2005 and 2013 within the Premier Healthcare Database, were used for analysis. The 90-day perioperative mortality was the primary outcome. Multivariable regression was used to predict the probability of mortality; models were adjusted for patient, hospital, and surgical characteristics. RESULTS: An increase in the number of complications resulted in an increasing predicted probability of mortality, with a precipitous increase if patients had four or more complications compared to one complication during hospitalisation following RC (index stay; 1.0-9.7%, P < 0.001) and during readmission (2.0-13.1%, P < 0.001). A readmission complication nearly doubled the predicted probability of postoperative mortality as compared to an initial complication (3.9% vs 7.4%, P < 0.001). During the initial hospitalisation cardiac- (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.9-5.1), pulmonary- (OR 4.8, 95% CI 2.8-8.4), and renal-related (OR 3.6, 95% CI 2-6.7) complications had the most significant impact on the odds of mortality across categories examined. CONCLUSIONS: The number and nature of complications have a distinct impact on mortality after RC. As complications increase there is an associated increase in perioperative mortality.
OBJECTIVE: To examine the incidence of perioperative complications after radical cystectomy (RC) and assess their impact on 90-day postoperative mortality during the index stay and upon readmission. PATIENTS AND METHODS: A total of 57 553 patients with bladder cancer (unweighted cohort: 9137 patients) treated with RC, at 360 hospitals in the USA between 2005 and 2013 within the Premier Healthcare Database, were used for analysis. The 90-day perioperative mortality was the primary outcome. Multivariable regression was used to predict the probability of mortality; models were adjusted for patient, hospital, and surgical characteristics. RESULTS: An increase in the number of complications resulted in an increasing predicted probability of mortality, with a precipitous increase if patients had four or more complications compared to one complication during hospitalisation following RC (index stay; 1.0-9.7%, P < 0.001) and during readmission (2.0-13.1%, P < 0.001). A readmission complication nearly doubled the predicted probability of postoperative mortality as compared to an initial complication (3.9% vs 7.4%, P < 0.001). During the initial hospitalisation cardiac- (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.9-5.1), pulmonary- (OR 4.8, 95% CI 2.8-8.4), and renal-related (OR 3.6, 95% CI 2-6.7) complications had the most significant impact on the odds of mortality across categories examined. CONCLUSIONS: The number and nature of complications have a distinct impact on mortality after RC. As complications increase there is an associated increase in perioperative mortality.
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Authors: Frédéric D Birkhäuser; Felix Moltzahn; Philipp M Huber; Jean-Luc Zehnder; Sebastian Flückiger; Daniel Hasler; Anirban P Mitra; Pascal Zehnder Journal: Eur Urol Open Sci Date: 2020-10-24