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OBJECTIVE To characterize the outcomes and predictors of readmission after robot-assisted radical cystectomy (RARC) during early (30-day) and late (31–90–day) postoperative periods. METHODS We retrospectively evaluated our prospectively maintained RARC quality assurance database of 272 consecutive patients operated between 2005 and 2012. We evaluated the relationship of readmission with perioperative outcomes and examined possible predictors during the postoperative period. RESULTS Overall 30- and 90-day mortality was 0.7% and 4.8%, respectively, with 25.5% patients readmitted within 90 days after RARC (61% of them were readmitted within 30 days and 39% were readmitted between 31–90 days postoperatively). Infection-related problems were the most common cause of readmission during early and late periods. Overall operative time and obesity were significantly associated with readmission (P = .034 and .033, respectively). Body mass index and female gender were independent predictors of 90-day readmission (P = .004 and .014, respectively). Having any type of complication correlated with 90-day readmission (P = .0045); meanwhile, when complications were graded on the basis of Clavien grading system, only grade 1–2 complications statistically correlated with readmission (P = .046). Four patients needed reoperation (2 patients in early “for appendicitis and adhesive small bowel obstruction” and 2 in late “for ureteroenteric stricture” readmission); meanwhile, 6 patients needed percutaneous procedures (4 patients in early “1 for anastomotic leak and 3 for pelvic collections” and 2 “for pelvic collections and ureterocutaneous fistula” in late readmission). CONCLUSION The rate of readmission within 90 days after RARC is significant. Female gender and body mass index are independent predictors of readmission. Outcomes at 90 days provide more thorough results, essential to proper patient counseling.

Objective• To externally validate currently available bladder cancer nomograms for prediction of all-cause survival (ACS), cancer-specific survival (CSS), other-cause mortality (OCM) and progression-free survival (PFS). Patients and Methods• Retrospective analysis of a prospectively maintained database of 282 patients who underwent robot-assisted radical cystectomy (RARC) at a single institution was performed.• The Bladder Cancer Research Consortium (BCRC), International Bladder Cancer Nomogram Consortium (IBCNC) and Lughezzani nomograms were used for external validation, and evaluation for accuracy at predicting oncological outcomes.• The 2-and 5-year oncological outcomes were compared, and nomogram performance was evaluated through measurement of the concordance (c-index) between nomogram-derived predicted oncological outcomes and observed oncological outcomes. Results• The median (range) patient age was 70 (36-90) years. At a mean follow-up of 20 months, local or distant disease recurrence developed in 30% of patients. With an overall mortality rate of 33%, 17% died from bladder cancer.• The actuarial 2-and 5-year PFS after RARC was 62% (95% confidence interval [CI] 54-68) and 55% (95% CI 46-63), respectively. • The actuarial 2-and 5-year ACS was 66% (95% CI [59][60][61][62][63][64][65][66][67][68][69][70][71][72] and 47% (95% CI 37-55), respectively, and the 2-and 5-year CSS was 81% (95% CI 74-86) and 67% (95% CI 57-76), respectively. Conclusions• Bladder cancer nomograms available from the current open RC literature adequately predict ACS, CSS and PFS after RARC.• However, prediction of advanced tumour stage and lymph node metastasis was modest and the Lughezzani nomogram failed to predict OCM.

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Objectives : To make a comparative evaluation of efficacy of brachial plexus blockade between supraclavicular subclavian perivascular technique and axillary transarterial technique with a tourniquet and also to compare the latency & potency of the block, to ascertain the risks of complications between the techniques and to compare the haemodynamic stability of the patient. Methods : For this purpose a total of 100 undergoing surgery for distal to the midarm. They were randomly selected by odd and even numbering method. These patients were divided into two groups (Group A: subclavian perivascular supraclavicular technique bearing all the odds numbers and Group B: transarterial axillary technique with a tourniquet bearing all the even numbers; fifty patients in each group. Results : The only exception is the mean on set time of sensory block was 11.0±2.6 minutes and 14.3±2.1 minutes in Group A and Group B respectively. The mean on set time of motor block were 18.3±3.9 minutes in Group A and 21.4±3.2 minutes in Group B. So the mean on set time of sensory block and motor block were statistically significant (p<0.05). Most of the patients found complete sensory block and complete motor block between two groups and no significant (p>0.05) difference was found in the present study. Adequate efficacy of block were predominate in both groups and no significant (p>0.05) difference was found. The level of satisfaction of surgeon and it was found that 92.0% in Group A and 94.0% in Group B were satisfied. Patient's co-operation was found 92.0% and 94.0% in Group A and Group B respectively. No significant (p>0.05) difference were found in terms of surgeon satisfaction and patients cooperation between two groups. Conclusion : It can be concluded that the supraclavicular subclavian perivascular technique and axillary transarterial technique with a tourniquet both are equally effective and safe method for providing brachial plexus block distal to midarm (Lower half of the arm, elbow, forearm and hand).